PROVIDER / PRACTICE APPLICATION INSTRUCTIONS


1. To Start a new application press the  "NEW APPLICATION" button.

2. You will be required to answer ALL the questions before you submit your final application. Press "SUBMIT FINAL APPLICATION" to submit your completed application.

A validation of your application will be completed before the application is submitted. If there are missed questions, or errors, a popup screen will indicate these errors. Please fix the errors and resubmit.

3. You may also save your answers before you submit your final application by pressing the "SAVE BUT DO NOT SUBMIT" button. After you save your answers you may immediately return to the application, or return at a later time to complete and submit your final application. Please note that the Save But Do Not Submit option does not validate your application. It only saves your answers.

YOU MUST COMPLETE SECTION A - Contact Information before you Save or Submit your application.

If you return at a later time, you must logon by entering your email address and your registration number. Your registration number is provided to you when you press the Save But Do Not Submit or Final Application buttons.

4. After you submit your final application, you may logon at a later time to check the status, which will be either "Under Review" or "Accepted."You will be notified directly by the PCMH Pilot staff of your application's status. Please do not expect to receive the notification prior to November 1, 2010.

5. You may print out a user-friendly version of your application after you Save or Submit your application. Press the link:
Print Application (Print-Friendly Version) and a popup window of the printable application will be displayed. Print the application and close the window.

6. Some questions are disabled (greyed-out) until you respond "Yes" to the previous question. Please allow a few seconds for the disabled question to be activated after you select "Yes".

7. There are several questions that require an explanation. Hint. Use a word processor and cut and paste your answer into the multiline text box. Also note the text box does not allow formatting for security reasons. Please be brief.

8. Please Note: The Maryland PCMH Program will select participants in the program by specific locations for a practice. A practice may apply to participate at more than one location, but you must submit separate applications for each location.