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Required Documentation

Eligible Professionals: Required Documentation

The following documents must be uploaded with your application:


  • Copy of the Practice Management Report supporting your volume.
  • Copy of the encounter report supporting the denominator (total encounters) for General Requirement 1 (50% of all encounters during the EHR reporting period were at locations with CEHRT).
  • Documentation from your EHR vendor stating the date you installed the 2014 or 2015 edition CEHRT.
  • MU Measure Report for the EHR reporting period including all measures and Clinical Quality Measure (CQM) information.
  • Documentation from Florida SHOTS, if not excluding because you provided no immunizations.
  • If attesting to active engagement with a Specialized Registry, documentation from the registry regarding status.
    • If excluding from a Specialized Registry, a signed letter from the provider supporting that they meet the exclusion criteria.
  • Copy of completed Security Risk Assessment (SRA) or review.

AS APPLICABLE

  • Additional Documentation Form if practicing at multiple locations.
  • Physician Assistant (PA) Led Attestation Form.
  • Advanced Registered Nurse Practitioners (ARNPs) or PAs billing under a supervising physician must include a copy of a medical record supporting your provision of a Medicaid service