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DIRECT Provider/Professional Information Form

All fields with the asterisk (*) are required.

Step 1: Identify Yourself
Step 2: Identify DC Clinical License or Medicaid Provider ID Number
Step 3: Create Your Direct Secure Messaging Directory Profile
Hospital, clinic, private office, etc.

I understand that I still have to contact CMS to update my data on their database. I have read the DC HIE HIPAA Privacy and Direct Privacy policies and procedures and the Direct Subscription Agreement.

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