Get Request Report - Division Of Professional Regulation - Delaware.gov

This guide provides clear, step-by-step instructions for filling out the Request Report for the Division of Professional Regulation in Delaware. The process is designed to be straightforward, ensuring that all necessary information is provided accurately and efficiently.

Follow the steps to complete the Request Report effectively.

1. Press the ‘Get Form’ button to access the Request Report and open it for filling out.
2. Complete the Requestor section, ensuring all fields are filled in, including your name, title, employment status, office phone, and office email. Both you and your supervisor will need to sign the form before submission.
3. In the Report Details section, specify the date range for the report you are requesting and provide an explanation for the report request.
4. Fill in the Patient (Medicaid Recipient) Information. Make sure to include the full name, date of birth, and Medicaid identification number of the recipient.
5. Select your preferred method of report delivery. You can choose to receive it via secure email or by certified mail. If you opt for secure email, confirm your email account is configured correctly.
6. Review the entire form to ensure all required fields are completed, then sign and date the form.
7. Finally, save your changes, and submit the form either by mail to the specified address or by secure email as outlined in the instructions.

Begin filling out your Request Report online today to ensure timely processing of your request.