Get Office Of Planning Data Request Form - Maryland Medical Programs - Mmcp Dhmh Maryland

Filling out the Office Of Planning Data Request Form is an essential step for individuals or organizations seeking data from the Maryland Medical Programs. This guide provides clear, step-by-step instructions on how to efficiently complete the form online.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the form and open it in your editing interface.
2. Enter the current date in the designated section at the top of the form.
3. Provide a clear project name in the specified field to identify your data request.
4. Fill in your contact information, including your name, title, organization, address, city, state, zip code, phone number, fax number, and email address.
5. Indicate the nature of your data request by selecting the appropriate checkbox, either for a new request or a new request using previously acquired data. If applicable, provide the title of the previous study and its IRB number.
6. Complete the research proposal section that may include a project abstract. You may attach additional documentation if needed to answer questions 5 and 6.
7. In the section for requested data, specify the time period, populations, diagnoses, services, service locations, and any providers related to your request.
8. Select the type of data you are requesting by checking the relevant box for managed care organization encounter data, HealthChoice program, PAC program, or fee-for-service claims data.
9. Review all filled sections for accuracy and completeness to ensure your request is clear and justified.
10. Once you have filled out all necessary sections, you can save your changes, download the completed form, print it, or share it as appropriate.

Begin the process by completing the Maryland Medical Programs Data Request Form online today.