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Phone:Fax:Medically Urgent Fax:Dartmouth Hitchcock Medical Center(603) 6952840 (603) 6764080 (603) 6401909Referring Provider: ___ Office Phone: ___ Practice Name: ___ Fax: ___ Practice Address ___PCP
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01
Visit the Dartmouth-Hitchcock Medical Center website
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Click on the 'Patient Services' tab
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Follow the prompts to fill out the Dartmouth Health - DHMC forms

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Dartmouth Hitchcock Medical Center (DHMC) is a hospital located in Lebanon, New Hampshire.
All healthcare providers and facilities affiliated with DHMC are required to file DHMC.
DHMC must be filled out online through the official website provided by DHMC.
The purpose of DHMC is to collect and report healthcare data for analysis and research purposes.
DHMC requires reporting of patient demographics, medical procedures, diagnoses, and outcomes.
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