The Bureau of Health Systems (BHS) uses an automated Provider Group List for the purpose of providing general information, program updates, alerts and clarifications via electronic mail to long-term care providers. E-mail is used exclusively to inform providers and others of Bureau updates. The Bureau also electronically transmits the Statement of Deficiencies (CMS-2567L) reports to facilities that have provided an e-mail address. Plans of Correction may be added to a printed report and returned by U.S. Mail or overnight delivery. Please download the latest version of Adobe Acrobat Reader (free Internet software) to view and print attachments.

Please submit this form as soon as possible if you have not registered previously or the facility e-mail address changes to receive electronically transmitted survey reports and to ensure continued BHS communications.

Note: Use the "Tab" key to move to the next field or "Restart" at the bottom of the form to start over. Using the "Enter" key instead of the Tab key will send the form before you can complete it. Print a copy of the page if you like before you press the "Submit" button at the end of the form. You will then receive a confirmation page.