CIR: Provider Registration Form

If you are already registered with CIR and intend to submit immunization data to fulfill Meaningful Use (MU), please enter your practice information and answer the questions.

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Provider Information


Contact Person

Do you currently provide immunizations to patients or are you planning to do so soon?
What age group of patients does your practice serve?
Operating fund type
Would you like to participate in the federal Vaccines for Children (VFC) program?
How do you plan to report immunizations to the CIR?
For Providers and Hospitals that need to register their Meaningful Use intent
Do you intend to submit immunization data to fulfill Meaningful Use (MU) requirements?
Please indicate which stage of MU you are currently working towards

Staff

Staff 1 Title
 

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