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OIG1:210, August 2022Application for Registration to Operate a Health Care Services Agency If you have questions regarding this registration form, please call (502) 5647963. Please answer all questions
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Obtain the Act 128 form from the Pennsylvania Department of Education website or a local school district office.
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Fill out the personal information section including name, address, and contact information.
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Provide your education background including the name of high school and graduation date.
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Include any additional information required such as test scores or extracurricular activities.
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Act 128 in Pennsylvania is a law that requires healthcare professionals to report certain medical information about individuals with drug and alcohol addiction.
Healthcare professionals, including doctors, nurses, and treatment providers, are required to file Act 128 in Pennsylvania.
Act 128 in Pennsylvania can be filled out online through the state's reporting system or by submitting a paper form with the required information.
The purpose of Act 128 in Pennsylvania is to track and monitor the treatment of individuals with drug and alcohol addiction to ensure they are receiving appropriate care and support.
Medical information such as diagnosis, treatment plans, and progress reports must be reported on Act 128 in Pennsylvania.
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