|To request a new site implementation or to renew or order a new program for an existing site fill out this form.
|If the practice is participating in MIPS as individuals each provider will need to complete and sign this consent form.
|If the practice is participating in MIPS as a group the groups security officer should complete and sign one consent form.
Modified on: Tue, 10 Oct, 2017 at 10:49 AM
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