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PUBLIC REPORTING OPTION REQUEST FORM CONTACT INFORMATION Contact Name: Clinic Name:Title:Address: Phone:Email:NOTE: For scores to be visible, at least 30 patients are required in a measure denominator,

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What is public reporting opt-in request?

Public reporting opt-in request is a formal request made by an individual or organization to choose to have certain information publicly reported.

Who is required to file public reporting opt-in request?

Any individual or organization who wishes to have specific information publicly reported is required to file a public reporting opt-in request.

How to fill out public reporting opt-in request?

To fill out a public reporting opt-in request, the individual or organization must provide their identifying information and specify the information they want to be publicly reported.

What is the purpose of public reporting opt-in request?

The purpose of a public reporting opt-in request is to allow individuals or organizations to control which information is made public.

What information must be reported on public reporting opt-in request?

The information that must be reported on a public reporting opt-in request includes the specific data, documents, or details that the individual or organization wants to be publicly disclosed.

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