Please fill out this registration form to start connecting with CurrentCare, Rhode Island’s statewide Health Information Exchange (HIE). If you have questions, please contact Support@CurrentCareRI.org or 888.858.4815. Section 1: Contact Information Official Organization Name: d/b/a Organization Name (if applicable): Organization Website: Organization Phone: Organization Address (main): Organization NPI Number: Contact Name: Contact Phone: Contact email: Contact Title: Section 2: Eligibility Questions Are you a licensed healthcare provider, or does your organization employ or contract with licensed healthcare providers to provide healthcare services in the state of Rhode Island? Yes No Does your organization have an active treating, payment, or healthcare operations relationship with patients in Rhode Island? Reference: HHS Guidance: Treatment, Payment, and Health Care Operations Yes No Section 3: Organization Information Please select your organization’s type below: Accountable Care Organization Ambulatory: Primary Care Practice Ambulatory: Behavioral Health First Responder FQHC (Federally Qualified Health Center) Government or Government Funded Clinical Hospital or Health System Long Term/Post-Acute Care Managed Care Organization/IPA Payer Pharmacy Radiology Center Specialty Medical Practice Urgent Care Other Please list all affiliations that apply: Does your organization use electronic health record (EHR) software? If so, please enter the EHR vendor name and/or software product name, or enter N/A if you do not use an EHR: Do you use the following lab services? LabCorp Quest None Does your organization represent itself as a substance use disorder (SUD) treatment provider under 42 CFR Part 2? Reference: SAMHSA.gov No Yes Only specific units, programs, or providers Not sure Would you like to participate in the HIE by sharing your patient information with other clinical providers through CurrentCare? Yes No Maybe, in the future Thank you for registering with CurrentCare! Our Client Services team will be in touch shortly to get started. Submit
