Get the free USIIS Provider Enrollment Agreement - Utah Department of Health - health utah
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Provider ID Provider Enrollment Agreement Facility Name: Type of Facility: A. B. C. D. Local Health Department Private Practice (Individual or Group) Long Term Care Center Pharmacy E. F. G. H. Indian
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What is usiis provider enrollment agreement?
The usiis provider enrollment agreement is a contract between healthcare providers and the Utah Statewide Immunization Information System (USIIS).
Who is required to file usiis provider enrollment agreement?
All healthcare providers in the state of Utah who administer immunizations are required to file the usiis provider enrollment agreement.
How to fill out usiis provider enrollment agreement?
The usiis provider enrollment agreement can be filled out online using the USIIS provider portal. Providers will need to provide their contact information, details about their practice, and agree to the terms and conditions outlined in the agreement.
What is the purpose of usiis provider enrollment agreement?
The purpose of the usiis provider enrollment agreement is to ensure that healthcare providers comply with the reporting requirements of the Utah Statewide Immunization Information System (USIIS).
What information must be reported on usiis provider enrollment agreement?
The usiis provider enrollment agreement requires healthcare providers to report demographic information about their practice, as well as details about the immunizations they administer and the patients they serve.
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