ODP COVID-19 Provider Information Tool
2%
Purpose:
To collect provider level information that will:
1.       Inform DHS/ODP about risk/service closures and guide decision making
2.       Create a record if Appendix K is implemented for the purposes of retroactive approvals, documentation and payment 

Providers, please complete this Information Tool as many times as needed to provide updates and changes.

Instructions: Please have all information ready to enter prior to beginning the survey. If left idle for too long, the survey will time out. After entering all information you will see a screen to review/print. An email will also be sent. Please save a copy and maintain in files.