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Please be aware that a pop-up will appear upon successful submission before being redirected back home.

Notice: Please ensure that we have all updated facesheets. Facesheets can be emailed to This information will be required to make Online Order Entry as quick and efficient for your nursing staff as possible. It may be easier to allow us access to your EMR. 

Please ensure that all files are properly compressed and appropriately encrypted before sending. 

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      Facility Info

    • 2

      Staff Info

    • 3

      Unit Info

    • 4

      Billing Info

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    Facility Info

    Facility Contact Information

    Administrator Information

    Director of Nursing Information

    Business Office Information

    IT Department Information

    Facility Unit Information

    Billing Office Information

    EMR System Information

    Can we have access to your EMR system? (required)

    Your EMR System (required)

    If "other", please specify what EMR system you use (required)

    Payor Type Information

    Do you have Part A Days? (required)
    Do you HMO Days? (required)

    Bed Type Information

    Do you have AL and/or IL beds? (required)
    Do you have an ABN on File for Medicare Part B patients? (required)
    (If not, click here to download our blank ABN form)

    Placing Standing Orders

    Do you have standing orders?

    Notice: It is vitally important that the standing orders indicate the months the orders are to be drawn. If the list of standing orders does not include dates, it will be necessary to ascertain the dates or make a decision on what dates you wish us to input all of your reoccurring orders. It will be important to make sure the laboratory orders we receive coincide with your physician’s orders.

    Submitting Physician Information

    Please ensure your file is in .pdf, .doc, or .docx format and under 5MBs in size.

    To help assist us as much as possible, please be aware that you'll need to assemble a listing of information you have on relevant physicians. This listing should include physicians' names, addresses, phone numbers, fax numbers, and NPI numbers. You may submit it as an attached document for convenience.