Eligible hospitals and professionals may use this form to notify the Washington State Department of Health of their intent to send Electronic Laboratory Reports, Syndromic Surveillance Data, Cancer Reports, Controlled Substance Requests Electronic Case Reporting and/or Immunization Information for the Electronic Health Record (EHR) Incentive Program. 

For more information, please contact MeaningfulUse@doh.wa.gov or visit our website. 

Information collected by this form may be subject to release in accordance with RCW 42.56 (Public Records Act). 

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