Attestation of Data Integrity: Data for this measure was captured from an Electronic Medical Records (EMR) using the one of the tools outlined in the “Participant Expectations” section of the Mental Health Screening Incentive Program guidelines.(Required) Are you reporting on the full population of patients or on the OneCare ACO attributed lives only?(Required) Which describes your practice?(Required) Note - if you select Single-TIN, multi-practice, you will be able to add on additional practices when filling out the form.
Single-TIN, Multi-Practice: Legal Business Name(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
For practices that have multiple sites associated with their single TIN#, please check the box after the follow-up screening reporting fields to add your next practice.
Mental Health Screening Initiative Follow-Up Reporting Add 2nd Practice
2nd Practice Legal Business Name - 2nd Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the second site associated with your single TIN# listed in this dropdown.
2nd Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
2nd Practice: Mental Health Screening Initiative Follow-Up Reporting Add 3rd Practice
3rd Practice Legal Business Name - 3rd Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the third site associated with your single TIN# listed in this dropdown.
3rd Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
3rd Practice: Mental Health Screening Initiative Follow-Up Reporting Add 4th Practice
4th Practice Legal Business Name - 4th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the fourth site associated with your single TIN# listed in this dropdown.
4th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
4th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 5th Practice
5th Practice Legal Business Name - 5th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the fifth site associated with your single TIN# listed in this dropdown.
5th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
5th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 6th Practice
6th Practice Legal Business Name - 6th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the sixth site associated with your single TIN# listed in this dropdown.
6th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
6th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 7th Practice
7th Practice Legal Business Name - 7th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the seventh site associated with your single TIN# listed in this dropdown.
7th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
7th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 8th Practice
8th Practice Legal Business Name - 8th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the eighth site associated with your single TIN# listed in this dropdown.
8th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
8th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 9th Practice
9th Practice Legal Business Name - 9th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the ninth site associated with your single TIN# listed in this dropdown.
9th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
9th Practice: Mental Health Screening Initiative Follow-Up Reporting Add 10th Practice
10th Practice Legal Business Name - 10th Practice(Required) Please select your legal business name. Brattleboro Memorial Hospital, Inc. - Brattleboro Family Medicine Brattleboro Memorial Hospital, Inc. - Maplewood Family Practice Brattleboro Memorial Hospital, Inc. - Putney Health Center Brattleboro Memorial Hospital, Inc. - Windham Family Practice Central Vermont Medical Center Inc. - CVMC Adult Primary Care-Barre Central Vermont Medical Center Inc. - CVMC Family Medicine-Berlin Central Vermont Medical Center Inc. - CVMC Family Medicine-Waterbury Central Vermont Medical Center Inc. - CVMC Integrative Family Medicine-Montpelier Central Vermont Medical Center Inc. - CVMC Pediatrics Primary Care-Berlin Central Vermont Medical Center Inc. - CVMC Green Mountain Family Practice Community Health Centers of Burlington Inc. - Champlain Islands Health Center Community Health Centers of Burlington Inc. - Community Health Centers of Burlington Community Health Centers of Burlington Inc. - Essex Health Center Community Health Centers of Burlington Inc. - Good Health Internal Medicine Community Health Centers of Burlington Inc. - South End Health Center Community Health Centers of Burlington Inc. - Winooski Family Health Community Health Centers of the Rutland Region, Inc. - Brandon Medical Center Community Health Centers of the Rutland Region, Inc. - Castleton Family Health Center Community Health Centers of the Rutland Region, Inc. - CHCRR Pediatrics Community Health Centers of the Rutland Region, Inc. - Mettowee Valley Family Health Center Community Health Centers of the Rutland Region, Inc. - Rutland Community Health Center Community Health Centers of the Rutland Region, Inc. - Shorewell Community Health Center Dartmouth-Hitchcock Clinic Dartmouth-Hitchcock Heater Road Evergreen Family Health Partners, LLP - Alder Brook Family Health Evergreen Family Health Partners, LLP - Evergreen Family Health Gifford Health Care, Inc. - Gifford Bethel Health Center Gifford Health Care, Inc.- Gifford Chelsea Health Center Gifford Health Care, Inc.- Gifford Health Center at Berlin- Primary Care Gifford Health Care, Inc.- Gifford Pediatrics & Adolescent Medicine Gifford Health Care, Inc.- Gifford Primary Care Gifford Health Care, Inc. - Rochester Health Center Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Cambridge Lamoille Health Partners, Inc. - Lamoille Health Family Medicine Morrisville Lamoille Health Partners, Inc. - Lamoille Health Pediatrics North Country Hospital and Health Center Inc. - North Country Pediatrics and Adolescent Medicine North Country Hospital and Health Center Inc. - North Country Primary Care Barton Orleans North Country Hospital and Health Center Inc. - North Country Primary Care Newport Northeastern Vermont Regional Hospital, Inc. - Kingdom Internal Medicine Northeastern Vermont Regional Hospital, Inc. - NVRH Corner Medical Northeastern Vermont Regional Hospital, Inc.- NVRH St. Johnsbury Pediatrics Northern Counties Health Care, Inc. - Concord Health Center Northern Counties Health Care, Inc. - Danville Health Center Northern Counties Health Care, Inc. - Hardwick Health Center Northern Counties Health Care, Inc. - Island Pond Health Center Northern Counties Health Care, Inc. - St. Johnsbury Community Health Center Porter Hospital, Inc. - PMC Pediatric Primary Care Porter Hospital, Inc. - PMC Primary Care - Brandon Porter Hospital, Inc. - PMC Primary Care - Middlebury Porter Hospital, Inc. - PMC Primary Care – Vergennes Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Peds Primary Care Health Partners - Vermont LLP - Brattleboro Primary Care - Adult Primary Care Health Partners - Vermont LLP - Cold Hollow Family Practice Primary Care Health Partners - Vermont LLP - Monarch Maples Pediatrics Primary Care Health Partners - Vermont LLP – Mt. Anthony Primary Care Primary Care Health Partners - Vermont LLP - St. Albans Primary Care Primary Care Health Partners - Vermont LLP - Timber Lane Pediatrics Southwestern Vermont Medical Center, Inc. - SVMC Deerfield Valley Campus Southwestern Vermont Medical Center, Inc. - SVMC Medical Associates Southwestern Vermont Medical Center, Inc. - SVMC Northshire Campus Southwestern Vermont Medical Center, Inc. - SVMC Pediatric Services Southwestern Vermont Medical Center, Inc. - SVMC Pownal Campus Springfield Medical Care Systems, Inc. DBA North Star Health - Charlestown Family Medicine Springfield Medical Care Systems, Inc. DBA North Star Health - Ludlow Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - MT Valley Health Center Springfield Medical Care Systems, Inc. DBA North Star Health - Springfield Health Center The Richford Health Center, Inc. - Enosburg Health Center The Richford Health Center, Inc. - Fairfax Health Center The Richford Health Center, Inc. - Georgia Health Center The Richford Health Center, Inc. - Notch Primary Care The Richford Health Center, Inc. - Richford Health Center The Richford Health Center, Inc. - St. Albans Health Center The Richford Health Center, Inc. - Swanton Health Center University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Burlington University of Vermont Medical Center Inc. - UVM Children's Hospital Pediatrics-Williston University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Essex Junction University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care South Burlington University of Vermont Medical Center Inc. - UVM Medical Center Adult Primary Care Williston University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Colchester University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Hinesburg University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine Milton University of Vermont Medical Center Inc. - UVM Medical Center Family Medicine South Burlington Windsor Hospital Corporation - Mt. Ascutney Physician Practices Adult Primary Care Windsor Hospital Corporation - Mt. Ascutney Physician Practices Peds Windsor Hospital Corporation - Ottauquechee Health Center
Please find the 10th site associated with your single TIN# listed in this dropdown.
10th Practice Screening - Reporting Period: January 1, 2025 to December 31, 2025
10th Practice: Mental Health Screening Initiative Follow-Up Reporting
Please explain any limitations on reporting a January 1, 2025 to December 31, 2025 screening rate or anything else you would like to share:
