Washington State Public Health Electronic Health Record Incentive Program Registration

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). 

IMPORTANT INSTRUCTIONS:

  • Do not use your browser's back button to review previous pages. If you do, you'll get kicked out and won't be able to get back in. Use the Back button at the bottom of each page.

  • If the questionnaire is left inactive for more than 15 minutes, when you return and attempt to continue, you'll get kicked out and won't be able to get back in. If you need to take a break, use the Save button at the bottom of each page. When you click the save button you will be asked for an email address and a message will be sent to that address with a link that will get you back into your saved survey.