Please read completely and follow the instructions below.
The registration must be completed by licensed providers whose scope of professional practice per licensing state laws and regulations and/or applicable governing authority permits them to prescribe medication and provide medical care, such as diagnosing, treating, and clinically managing patients with orthopoxvirus infections.
New providers who have not previously submitted any TPOXX IND forms (Form FDA 1572, Patient Intake, and/or Clinical Outcome) to CDC must register as a participating provider with their facility information under the CDC-held EA-IND protocol to provide TPOXX treatment. Please follow the instructions below to complete the Full Registry. Providers and affiliated staff who have been providing TPOXX treatment under one umbrella 1572 submitted to CDC prior to the online registry, but whose individual email addresses were not included in the TPOXX IND forms (Patient Intake and/or Clinical Outcome) submitted to CDC prior to this online registry, will need to register online to gain access to the electronic TPOXX IND forms . Please follow the instructions below to complete the Abbreviated Registry. Those providers and affiliated facilities that received an email from "DCIPHER (CDC)" on October 25, 2022 with instructions to access secure links to the Patient Intake and Clinical Outcome forms without having completed an online registry (referred to as grandfathered), these links have expired. Providers need to register online to obtain access to the electronic TPOXX IND forms . The tokenized links to these electronic forms expire 180 days from issuance . If you have links that are expired or are not working, please re-register online to obtain new tokenized links to the electronic TPOXX IND forms. For questions on TPOXX IND registry or electronic forms, please email regaffairs@cdc.gov .
1) Choose a statement that applies to you. The appropriate section will display on your screen based on your response. I am a licensed provider qualified to diagnose and clinically manage orthopoxvirus infected patients and....
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have not previously submitted any TPOXX IND forms to CDC or completed this online registry.
have previously submitted Form FDA 1572 and TPOXX IND forms prior to this online registry, but I did not receive an email to gain access to electronic TPOXX IND forms.
have been providing TPOXX treatment but need to register with my own email address to gain access to the electronic TPOXX IND forms.
have received an email to access the electronic TPOXX IND forms but need to add additional staff members under my registry.
have previously completed this online registry, but links to the electronic TPOXX IND forms have expired and need to re-register to obtain updated links.
Abbreviated Registry The abbreviated registry is for providers whose affiliated facilities is already a registered site. Select your facility from the registered facilities in the drop down.
Full Registry All new providers to TPOXX IND program as well as providers and their affiliated facilities that have not previously submitted any TPOXX IND forms to CDC prior to the online registry must complete a full registry. Follow the instruction below.
2)
First and Last Name
3) Please select and provide information for one of the following:
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Provider license #
National provider identifier #
DEA #
To which jurisdiction is the license associated with?
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Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Republic of Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
4) Licensed provider's work email address
* must provide value
5) I cannot find my facility name 1LIFE / ONE MEDICAL 26 HEALTH 72ND STREET MEDICAL ASSOCIATES ABBOTT NORTHWESTERN GENERAL MEDICINE ASSOCIATES ABBOTT NORTHWESTERN HOSPITAL ABRAZO WEST CAMPUS ABSOLUTE CARE ABSOLUTECARE MEDICAL CENTER ACCESS IPA ACENSION MERCY ADVANCED MEDICAL NAPLES ADVENT HEALTH DAYTONA BEACH ADVENTHEALTH DELAND HOSPITAL ADVENTHEALTH EAST ORLANDO ADVENTHEALTH FISH MEMORIAL HOSPITAL ADVENTHEALTH OCALA ADVENTHEALTH ORLANDO ADVENTHEALTH SHAWNEE MISSION ADVENTHEALTH TAMPA ADVENTIST HEALTH WMMC ADVOCATE AURORA ADVOCATE ILLINOIS MASONIC MEDICAL CENTER ADVOCATE MEDICAL GROUP AFC URGENT CARE PORTLAND AFFILIATED MEDICAL ASSOCIATES AHF AHF AIDS HEALTHCARE FOUNDATION AHF ATLANTA MIDTOWN HEALTHCARE CENTER AHF CAPITAL HILLS DC AHF DALLAS AHF HEALTHCARE CENTER AHF HOLLYWOOD-RESEARCH AHF KINDER AHF LIBERTY CITY AHF NORTHPOINT AHF OAKLAND PARK AHF OPK AHF ORG AHF ORLANDO AHF PHILADELPHIA AHF SOUTH BEACH AHF ST. PETERSBURG HCC AHF WESTSIDE - AHF RESEARCH AHMC SETON MEDICAL CENTER AHU-ST. VINCENT HOSPITAL AIDS HEALTHCARE FOUNDATION AKRON CITY HOSPITAL ALABAMA DEPT OF PUBLIC HEALTH ALABAMA MEDICAL GROUP ALACHUA COUNTY HEALTH DEPARTMENT ALACUHA COUNTY HEALTH DEPARTMENT ALAMEDA HEALTH SYSTEM ALEXANDRIA HEALTH DEPARTMENT ALICIA ALMENDRAL MD ALL CARE MEDICAL ALLEGHENY COUNTY HEALTH DEPARTMENT ALLEGHENY HEALTH NETWORK - POSITIVE HEALTH CLINIC ALLIANCE MEDICAL CLINIC ALLIES FOR HEALTH + WELLBEING ALLINA HEALTH ALTA BATES SUMMIT MEDICAL CENTER ALTAMED HEALTH SERVICES AMERICAN UNIVERSITY STUDENT HEALTH CENTER ANCHOR HEALTH ANDREW ESCAJEDA WESLEY HEALTH CENTERS ANN ARBOR VA MEDICAL CENTER ANTELOPE VALLEY MEDICAL OFFICES APICHA COMMUNITY HEALTH CENTER APLA APLA HEALTH APLA HEALTH & WELLNESS APLA HEALTH & WELLNESS - OUT HERE BALDWIN HILLS APLA HEALTH & WELLNESS MID-WILSHIRE CLINIC APLA HEALTH AND WELLNESS ARARAT ARIZONA STATE UNIVERSITY HEALTH SERVICES ARKANSAS DEPARTMENT OF HEALTH INFECTIOUS DISEASE BRANCH ARROWHEAD REGIONAL MEDICAL CENTER ASCENCION MERCY ASCENSION HEALTH GROUP ASCENSION MACOMB-OAKLAND HOSPITAL ASCENSION PROVIDENCE ASCENSION PROVIDENCE HOSPITAL, NOVI ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD ASCENSION PROVIDENCE ROCHESTER ASCENSION SAINT JOSEPH HOSPITAL ASCENSION SAINT MARY ASCENSION SAINTS MARY AND ELIZABETH MEDICAL CENTER ASCENSION ST JOHN CENTER FOR INTERNAL MEDICINE ASCENSION ST. VINCENT HOSPITAL ASCENSION ST. VINCENT'S ASIAN HEALTH SERVICES ASTOR MEDICAL ATLANTA VA HEALTHCARE SYSTEM ATLANTA VA MEDICAL CENTER ATRIUM HEALTH ATRIUM HEALTH - CAROLINAS MEDICAL CENTER ATRIUM HEALTH WAKE FOREST BAPTIST ATRIUM MERCY HOSPITAL ATRIUS HEALTH - KENMORE AUDIE L MURPHY VA HOSPITAL AUSTIN PUBLIC HEALTH (APH) SEXUAL HEALTH CLINIC AUSTIN REGIONAL CLINIC AVENUE 360 BALTIMORE CITY HEALTH DEPARTMENT SEXUAL HEALTH CLINIC BALTIMORE WASHINGTON MEDICAL CENTER BANNER ESTRELLA MEDICAL CENTER BANNER THUNDERBIRD MEDICAL CENTER BANNER THUNDERBIRD MEDICAL CENTER BANNER UNIVERSITY MEDICAL CENTER - TUCSON BANNER UNIVERSITY PHOENIX BANYAN INTEGRATIVE HEALTH BAPTIST HEALTH LOUISVILLE BAPTIST HEALTH MEDICAL CENTER LITTLE ROCK BAPTIST HOSPITAL MAIN BAPTIST HOSPITAL OF MIAMI BAPTIST MEDIAL CENTER BAPTIST MEMORIAL HOSPITAL BARTZ-ALTADONNA COMMUNITY HEALTH CENTER BATON ROUGE GENERAL MEDICAL CENTER BAY AREA HOSPITAL BAY PINES VA MEDICAL CENTER BAYFRONT HEALTH BAYLOR SCOTT & WHITE HEALTH - TEMPLE BAYLOR UNIVERSITY BAYSHORE MEDICAL BAYSTATE MEDICAL CENTER BE WELL FAMILY CARE BEAUMONT HOSPITAL - DEARBORN BEAUMONT HOSPITAL ROYAL OAK BEAUMONT MEDICAL CENTER CLINIC BEBASHI TRANSITION TO HOPE WELLNESS CENTER BELL FLOWER CLINIC BELL PRIMARY CARE BELLEVUE BEN TAUB HOSPITAL BETANCES HEALTH CENTER BETH ISRAEL DEACONESS MEDICAL CENTER BETHESDA N. HOSPITAL BIRCH TREE MEDICAL ASSOCIATES BIRCH TREE MEDICAL ASSOCIATES BISCAYNE MEDICAL BJC MEDICAL GROUP BOCA RATON REGIONAL BOISE VA MEDICAL CENTER BORREGO HEALTH STONEWALL OFFICE BOSTON MEDICAL CENTER BOWLING GREEN BRANDON REGIONAL HOSPITAL BRIDGEPORT HOSPITAL BRIDGEPORT HOSPITAL BRIGHAM AND WOMEN'S HOSPITAL BRONSON METHODIST HOSPITAL BRONX CARE BRONX VA MEDICAL CENTER BROOKDALE HOSPITAL MEDICAL CENTER BROWARD HEALTH BROWARD HEALTH CLINICA DE LAS AMERICAS BROWARD HEALTH COMPREHENSIVE CARE CENTER BROWARD MAIN JAIL BSW MCLANE CHILDREN'S HOSPITAL BSWH MEDICAL CENTER IRVING BUNCOMBE COUNTY HEALTH AND HUMAN SERVICES BUTTERWORTH HOSPITAL CALLEN LORDE COMMUNITY HEALTH CENTER CAMBRIDGE HOSPITAL CAN COMMUNITY HEALTH CANO HEALTH CAPE FEAR VALLEY MEDICAL CENTER CAPITAL HEALTH CAPITAL REGIONAL MEDICAL CENTER CAPT JAMES A. LOVELL FEDERAL HEALTH CARE CENTER CAPT JAMES A. LOVELL FEDERAL HEALTH CARE CENTER CARBON HEALTH CARE CLINIC CARE RESOURCE CAREPOINT HEALTH CHRIST HOSPITAL CARILION ROANOKE MEMORIAL HOSPITAL CARL T HAYDEN VA CARLE FOUNDATION HOSPITAL CAROLINN INTERNAL MEDICINE AND PEDIATRICS CAROMONT HEALTH CATHOLIC MEDICAL CENTER CCPHD FLAGSTAFF MEDICAL CENTER CEDARS SINAI INTERNAL MEDICINE CEDARS SINAI MEDICAL CENTER CEDARS SINAI URGENT CARE - WILSHIRE CENTENNIAL IM CONTINUITY CLINIC CENTER OF EXCELLENCE FOR HIV/AIDS CARE, QUILLEN COLLEGE OF MEDICINE, ETSU CENTINELA HOSPITAL MEDICAL CENTER CENTRAL ARKANSAS VETERAN'S HEALTHCARE SYSTEM CENTRAL HEALTH CENTER CENTRAL MAINE HEALTHCARE (CMMC/RH/BH) CENTRAL MAINE MEDICAL CENTER CENTRAL OUTREACH WELLNESS CENTER CENTRAL VIRGINIA VA HEALTH CARE SYSTEM CENTRO LATINOAMERICANO DE EMFERMEDADES DE TRANSMISION SEXUAL (CLETS) CHARLES B WANG CHC CHAS HEALTH CHESAPEAKE REGIONAL MEDICAL CENTER CHESTERFIELD HEALTH DISTRICT CHILDREN MEDICAL CENTER DALLAS CHILDREN'S HOSPITAL AND MEDICAL CENTER CHILDREN'S HOSPITAL LOS ANGELES CHILDREN'S HOSPITAL OF GEORGIA CHILDREN'S HOSPITAL OF PHILADELPHIA CHILDREN'S NATIONAL HOSPITAL CHRISTIANACARE CHRISTUS SANTA ROSA CHRISTUS SANTA ROSA HOSPITAL CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER CIRCLE CARE CENTER CITY OF LONG BEACH DEPARTMENT OF HEALTH AND HUMAN SERVICES CITY OF MILWAUKEE HEALTH DEPARTMENT CITY OF MILWAUKEE HEALTH DEPARTMENT CITYMD CLASSEN URGENT CARE CLINIC CLAUDIA T MARTORELL MD LLC CLEARLYDERM CLEMENT J ZABLOCKI VAMC CLEMENTS UNIVERSITY HOSPITAL CLEVELAND CLINIC FOUNDATION CLEVELAND CLINIC MARTIN HEALTH COLLEGE MEDICAL CENTER ED COLUMBIA UNIVERSITY IRVING MEDICAL CENTER / NEW YORK PRESBYTERIAN HOSPITAL COLUMBUS PUBLIC HEALTH COMMUNITY HEALTH CLINIC COMMUNITY HEALTHCARE NETWORK COMMUNITY HOSPITAL NORTH COMMUNITY HOSPITAL OF THE MONTEREY PENNINSULA COMMUNITY MEMORIAL HOSPITAL COMMUNITY REGIONAL MEDICAL CENTERS AND UCSF FRESNO COMMUNITYCARE DAVID POWELL CLINIC COMPLETE FAMILY CARE COMPREHENSIVE HEALTH CARE CENTER CONE HEALTH ALAMANCE REGIONAL MEDICAL CENTER CONE HEALTH REGIONAL CENTER FOR INFECTIOUS DISEASE CONFLUENCE HEALTH, CENTRAL CAMPUS CONTRA COSTA REGIONAL MEDICAL CENTER COOK CHILDREN'S MEDICAL CENTER COOKEVILLE REGIONAL MEDICAL CENTER COOKEVILLE REGIONAL MEDICAL CENTER COOPER UNIVERSITY HEALTH/HOSPITAL CORE CENTER CORPORAL MICHAEL J. CRESCENZ VA MEDICAL CENTER COTTONWOOD INSTACARE COUNTY OF SAN DIEGO CRATER HEALTH DISTRICT CREW HEALTH CARE CRISP REGIONAL HOSPITAL CROFOOT MD CROSSOVER HEALTH CROSSOVER HEALTH CROSSOVER HEALTH MARYVALE DALLAS COUNTY HEALTH AND HUMAN SERVICES DAMIEN CARES DAP HEALTH DC HEALTH & WELLNESS CENTER DEACONESS CLINIC URGENT CARE NORTH PARK DEKALB COUNTY BOARD OF HEALTH DENNIS AVE HEALTH CENTER DENVER HEALTH DEPARTMENT OF HEALTH CROSSROAD CLINIC DEPARTMENT OF HEALTH CROSSROAD CLINIC DEPT OF HEALTH SERVICES DERMATOLOGY CONSULTANTS, P.A. DERMATOLOGY CONSULTANTS, P.A. DERMATOLOGY CONSULTANTS, P.A. DETROIT MEDICAL CENTER DIGNITY HEALTH MEDICAL GROUP DMC SINAI GRACE HOSPITAL DOCTORS MEDICAL CENTER MODESTO DOMINICAN HOSPITAL DR. G'S URGENT CARE DREXEL PARTNERSHIP COMPREHENSIVE CARE PRACTICE DUKE UNIVERSITY MEDICAL CENTER DUNES FAMILY CLINIC DUPONT CIRCLE PHYSCIANS EAST BAY ADVANCED CARE EAST BAY AIDS CENTER / ALTA BATES SUMMIT MEDICAL CENTER EAST INTERSTATE FAMILY MEDICINE, KAISER PERMANENTE NORTHWEST EASTERN VIRGINIA MEDICAL SCHOOL EASTERN VIRGINIA MEDICAL SCHOOL EDWARD HINES VA MEDICAL CENTER EG HEALTHCARE EINSTEIN MEDICAL CENTER PHILADELPHIA EISENHOWER HEALTH CENTER EL PASO COUNTY PUBLIC HEALTH EL RIO HEALTH EMORY UNIVERSITY HOSPITAL EMORY UNIVERSITY HOSPITAL MIDTOWN EMPOWERMENT RESOURCE CENTER ENGLEWOOD HEALTH/LEONIA MEDICAL ASSOCIATES ENTERTAINMENT MEDICAL GROUP, INC EQUITAS HEALTH ESKENAZI HEALTH ESTER YOON MD INC ETN MEDICAL INFUSION EXER URGENT CARE FAMILY HEALTH - MOBILE COUNTY HEALTH DEPARTMENT FAMILY HEALTH CARE FAMILY HEALTH CENTERS OF SAN DIEGO FAMILY HEALTH CENTERS OF SAN DIEGO FAMILY PRACTICE ASSOCIATES FARGO CASS PUBLIC HEALTH FENWAY HEALTH FERNDALE OPEN DOOR COMMUNITY HEALTH CENTER FL MD DO ASSOCIATES HOSPITAL FLORIDA DEPARTMENT OF HEALTH FLORIDA DEPARTMENT OF HEALTH HILLSBOROUGH FLORIDA DEPARTMENT OF HEALTH IN SEMINOLE COUNTY FLORIDA DEPARTMENT OF HEALTH LANTANA FLORIDA DEPARTMENT OF HEALTH PINELLAS FLORIDA DEPARTMENT OF HEALTH WEST PALM BEACH FLORIDA DEPARTMENT OF HEALTH, UNIVERSITY AREA HEALTH CENTER FLOYD COUNTY HEALTH DEPARTMENT FONTANA FAMILY HEALTH CENTER FRANCISCAN HEALTH-DYER FRANCISCAN INFECTIOUS DISEASE ASSOCIATES FROEDTERT HOSPITAL / MEDICAL COLLEGE OF WISCONSIN FT. GREENE STI NYCDOH FULL CIRCLE HEALTH FULL CIRCLE HEALTH - RAYMOND FULTON COUNTY BOARD OF HEALTH GALILEO HEALTH GALT DERMATOLOGY GARDEN CITY HOSPITAL GARDENA MEMORIAL HOSPITAL GEDEON MEDICAL CENTER GEORGE E. WAHLEN VA MEDICAL CENTER GEORGE WASHINGTON UNIVERSITY GEORGETOWN UNIVERSITY HOSPITAL GLENBROOK HOSPITAL GLENDALE MEMORIAL HOSPITAL GO CARE COMMUNITY HEALTH CENTER GOOD SAMARITAN HOSPITAL GOOD SAMARITAN HOSPITAL CORVALLIS GOTHAM MEDICAL GROUP GRADY HEALTH GRADY HEALTH / PONCE DE LEON CLINIC GRAND AVE URGENT CARE GRAVES GILBERT CLINIC WALK-IN CARE GREATER NEW BEDFORD COMMUNITY HEALTH CENTER GREENVILLE MEMORIAL HOSPITAL GW MEDICAL FACULTY ASSOCIATES HACKENSACK UNIVERSITY MEDICAL CENTER HADLEY FAMILY PRACTICE HAMILTON COUNTY HEALTH DEPARTMENT HAMPTON VAMC HARBOR UCLA MEDICAL CENTER HARLEM HOSPITAL CENTER HARMONY HEALTHCARE ORLANDO HARTFORD HOSPITAL HATTIESBURG FAMILY HEALTH CENTER HCA FLORIDA AVENTURA HCA FLORIDA TRINITY HOSPITAL HCA FLORIDA UNIVERSITY HOSPITAL HCA HOUSTON HEALTHCARE CLEAR LAKE HCA HOUSTON HEALTHCARE WEST HCA HOUSTON KINGWOOD HCA SOUTH TAMPA HEALTH CARE ADVOCATES HEALTH CENTER #1 - PDPH STD CLINIC HEALTH CENTRAL HOSPITAL HEALTH PARTNERS WOODBURY CLINIC HEALTH PARTNERS/REGIONS HOSPITAL HEALTH SERVICES CENTER, INC HEALTH SERVICES CENTER, INC. HEARTLAND HEALTH CENTERS HENDERSONVILLE MEDICAL CENTER HENNEPIN COUNTY HEALTHCARE HENRY FORD HEALTH HENRY FORD MACOMB HOSPITAL HENRY MAYO NEWHALL HOSPITAL HERITAGE HEALTH CARE CENTER HIALEAH HOSPITAL HMC MODERATE NEEDS SERVICES HMGS DERMATOLOGY HOAG HOSPITAL HOLLADAY INSTACARE HOLY CROSS HOSPITAL SILVER SPRING HOLY NAME MEDICAL CENTER HOLY NAME MEDICAL CENTER. HOMESTEAD HOSPITAL HOPE ACROSS GLOBE HOSPITAL DAMAS HOSPITAL MENONITA CAGUAS HOSPITAL MUNICIPAL DE SAN JUAN HOSPITAL OF CENTRAL CONNECTICUT HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HOUSTON METHODIST HOWARD BROWN HEALTH HOWARD COUNTY HEALTH DEPARTMENT HU HU KAM MEMORIAL HOSPITAL HUNTER HOLMES MCGUIRE VA MEDICAL CENTER HUNTINGTON HOSPITAL HUNTRIDGE FAMILY CLINIC ID CARE ID SPECIALISTS, PA ILLINOIS MASONIC MEDICAL CENTER IMMUNOLOGY CLINIC ARECIBO, PUERTO RICO DEPARTMENT OF HEALTH INCLUSIVE CARE GROUP INDIANA UNIVERSITY HEALTH INDIANA UNIVERSITY METHODIST HOSPITAL INFECTION MEDICINE & TRAVEL PROGRAM INFECTIOUS DISEASE DOCTORS MEDICAL GROUP INFECTIOUS DISEASE RESOURCE GROUP INFECTIOUS DISEASE SPECIALIST OF LONG BEACH INFECTIOUS DISEASE SPECIALISTS OF NORTHWEST ARKANSAS [IDS OF NWA] INFECTIOUS DISEASES ASSOCIATES INFECTIOUS DISEASES PHYSICIANS INOVA JUNIPER PROGRAM INSTITUTE FOR FAMILY HEALTH INTEGRIS BAPTIST MED CTR. INTERFAITH MEDICAL CENTER INTERMOUNTAIN HEALTHCARE INTERNAL MEDICINE GROUP RESIDENCY CLINIC MCLAREN FLINT INTERNAL MEDICINE GROUP RESIDENCY CLINIC MCLAREN FLINT JACKSON FAMILY MEMORIAL JACKSON HEALTH SYSTEM JACKSON MEMORIAL HOSPITAL JACKSON NORTH MEDICAL CENTER JACOBI MEDICAL CENTER JAMAICA HOSPITAL MEDICAL CENTER JEANES HOSPITAL JEFFERSON COUNTY DEPARTMENT OF HEALTH JEFFERSON HEALTH JESSE BROWN VETERANS AFFAIRS MEDICAL CENTER JOHN BELL HEALTH CENTER JOHNS HOPKINS HOSPITAL JONATHAN LAX TREATMENT CENTER JPS HOSPITAL JPS HOSPITAL JWCH INSTITUTE / WESLEY HEALTH CENTER KADLEC REGIONAL MEDICAL CENTER KADLEC REGIONAL MEDICAL CENTER KAISER MOANALUA KAISER OAKLAND MEDICAL CENTER KAISER PERMANENTE KAISER PERMANENTE ALTON KAISER PERMANENTE ANAHEIM KAISER PERMANENTE BALDWIN PARK KAISER PERMANENTE CAPITOL HILL MEDICAL CENTER KAISER PERMANENTE CENTRAL VALLEY STOCKTON KAISER PERMANENTE DOWNEY KAISER PERMANENTE FONTANA KAISER PERMANENTE FREMONT KAISER PERMANENTE FRESNO KAISER PERMANENTE LOS ANGELES KAISER PERMANENTE MARTINEZ MEDICAL OFFICES KAISER PERMANENTE MID-ATLANTIC KAISER PERMANENTE NAPA KAISER PERMANENTE OAKLAND KAISER PERMANENTE PANORAMA CITY KAISER PERMANENTE RIVERSIDE KAISER PERMANENTE ROS KAISER PERMANENTE RWC KAISER PERMANENTE SACRAMENTO KAISER PERMANENTE SAN DIEGO ZION KAISER PERMANENTE SAN FRANCISCO KAISER PERMANENTE SAN JOSE KAISER PERMANENTE SAN LEANDRO KAISER PERMANENTE SAND CANYON KAISER PERMANENTE SANTA CLARA KAISER PERMANENTE SANTA CLARADATE KAISER PERMANENTE SANTA ROSA KAISER PERMANENTE SOUTH BALTIMORE MEDICAL CENTER KAISER PERMANENTE SOUTH BAY KAISER PERMANENTE SOUTH SACRAMENTO KAISER PERMANENTE TACOMA MEDICAL CENTER KAISER PERMANENTE VACAVILLE KAISER PERMANENTE ZION KAISER PERMANENTE/ALTON SAND CANYON MEDICAL OFFICE BUILDING KAISER WOODLAND HILLS KC CARE HEALTHCARE KELSEY-SEYBOLD KEYSTONE HEALTH KIND CLINIC OAK LAWN KIND CLINIC SAN ANTONIO KIND CLINIC SOUTH AUSTIN KINGS COUNTY HOSPITAL KINGSBROOK JEWISH KINGSTON FAMILY HEALTH CENTER KINTEGRA KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT LA CLINICA DE LA RAZA LA CLINICA DEL PUEBLO LA COUNTY DEPARTMENT OF HEALTH SERVICES LA LGBT CENTER LAC - DHA - OFFICE OF DIVERSION & REENTRY LAC & USC MEDICAL CENTER LAHEY HOSPITAL AND MEDICAL CENTER LAKE ERIE COLLEGE OF MEDICINE ST CLAIR HOSPITAL LAKELAND REGIONAL HEALTH LANCASTER GENERAL LANKENAU MEDICAL ASSOCIATES LANKENAU MEDICAL CENTER LARKIN COMMUNITY HOSPITAL LAS CRUCES PUBLIC HEALTH OFFICE LASER SURGERY CARE LAZARUS DERMATOLOGY LE BONHEUR CHILDREN'S HOSPITAL LEGACY COMMUNITY HEALTH LEGACY EMANUAL MEDICAL CENTER LEGACY MERIDIAN PARK HOSPITAL LEGACY MERIDIAN PARK HOSPITAL LEMUEL SHATTUCK HOSPITAL LENOX HILL HOSPITAL LEON COUNTY HEALTH DEPARTMENT LGHP COMPREHENSIVE CARE LIFE LONG MEDICAL CENTER LIFEWAY LINCOLN HOSPITAL LIVWELL COMMUNITY HEALTH SERVICES LIVWELL COMMUNITY HEALTH SERVICES LOMA LINDA UNIVERSITY HEALTH CENTER LONG BEACH COMPREHENSIVE HEALTH CENTER LONG BEACH EDUCATION AND RESEARCH CONSULTANTS LONG BEACH MEMORIAL MEDICAL CENTER LONG ISLAND JEWISH MEDICAL CENTER LOS ANGELES PRIMARY CARE LOW COUNTRY HEALTH CARE SYSTEM LOWELL COMMUNITY HEALTH CENTER LOYOLA LYNCHBURG GENERAL HOSPITAL LYNDON B JOHNSON HOSPITAL MADERA COUNTY DEPARTMENT OF PUBLIC HEALTH MAIMONIDES MEDICAL CENTER MANATEE MEMORIAL HOSPITAL MANN-GRANDSTAFF VA MEDICAL CENTER MAPLE CITY HEALTH CARE CENTER MARINA DEL REY HOSPITAL MARION COUNTY DEPARTMENT OF HEALTH MARION COUNTY PUBLIC HEALTH DEPARTMENT MARSHALL MEDICAL CENTER MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL MASSACHUSETTS GENERAL HOSPITAL MATSUDA OFFICE MATTHEW 25 AIDS SERVICES MAYO CLINIC MAYO CLINIC HOSPITAL ARIZONA MAZZONI CENTER MCKENZIE WILLAMETTE MEDICAL CENTER MCLAREN OAKLAND MCLEOD REGIONAL MEDICAL CENTER MCMACKIN & ZIMNOCH MD PROGRESSIVE CARE MEASE DUNEDIN HOSPITAL MEDICAL CITY ARLINGTON MEDICAL CITY ARLINGTON MEDICAL OFFICES OF MANHATTAN MEDICAL UNIVERSITY OF SOUTH CAROLINA MEDPROVIDER MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL MEDSTAR HARBOR HOSPITAL PRIMARY CARE AT FEDERAL HILL MEDSTAR SOUTHERN MARYLAND MEDSTAR UNION MEMORIAL HOSPITAL MEDSTAR WASHINGTON HOSPITAL CENTER MEMORIAL CARE BICKERSTAFF FAMILY CENTER MEMORIAL DIVISION OF INFECTIOUS DISEASE MEMORIAL HEALTHCARE SYSTEM MEMORIAL HERMANN GREATER HEIGHTS HOSPITAL MEMORIAL HERMANN SOUTHWEST MEMORIAL HERMANN TMC MEMORIAL HOSPITAL GULFPORT MEMORIAL HOSPITAL OF GARDENA MEMORIAL HOSPITAL PEMBROKE MEMORIAL HOSPITAL WEST MEMORIAL MEDICAL CENTER MODESTO MEMORIAL REGIONAL HOSPITAL SOUTH MEND URGENT CARE MENORAH MEDICAL CENTER MEN'S HEALTH FOUNDATION MERCY HEALTH MERCY HEALTH ST. ANNE HOSPITAL MERCY REGIONAL MEDICAL CENTER METHODIST METHODIST DALLAS MEDICAL CENTER METHODIST RICHARDSON MEDICAL CENTER METHODIST SOUTH HOSPITAL METHODIST SPECIALTY AND TRANSPLANT HOSPITAL METRO COMMUNITY HEALTH CENTER METRO INCLUSIVE HEALTH METRO PUBLIC HEALTH DEPARTMENT METROHEALTH MIAMI BEACH COMMUNITY HEALTH CENTER MIAMI VA MEDICAL CENTER MICHAEL E DEBAKEY VA MEDICAL CENTER MICHIGAN MEDICINE MIDLAND MEDICAL MIDTOWN PUBLIC HEALTH OFFICE MIDTOWN PUBLIC HEALTH OFFICE MIDWAY SPECIALTY CARE CENTER MILFORD REGIONAL MEDICAL CENTER MILLER CHILDREN'S HOSPITAL MILLS PENINSULA MEDICAL CENTER MINNEAPOLIS VA MEDICAL CENTER MINNESOTA DEPARTMENT OF HEALTH MIRIAM HOSPITAL INFECTIOUS DISEASES & IMMUNOLOGY CENTER MISSION HOSPITAL MISSION NEIGHBORHOOD HEALTH CENTER MLK URGENT CARE MMP SPRING ST. HEALTH CENTER MONTAGE MEDICAL GROUP/RYAN RANCH MONTEFIORE MOORE REGIONAL HOSPITAL MORRISTOWN MEDICAL CENTER MORTON PLANT HOSPITAL MOUNT AUBORN HOSPITAL MOUNT CARMEL EAST MOUNT SINAI MOUNT SINAI (QUEENS) MOUNT SINAI HOSPITAL MOUNT SINAI INSTITUTE FOR ADVANCED MEDICINE MOUNT SINAI MEDICAL CENTER MOUNT SINAI WEST MOUNTAIN PARK HEALTH CENTER MOUNTAIN PARK HEALTH CENTER - MARYVALE MOUNTAIN VIEW HOSPITAL MPG INFECTIOUS DISEASE MULTICARE MULTICARE HEALTH SYSTEM MULTNOMAH COUNTY HEALTH DEPARTMENT MUNSON FAMILY PRACTICE MUSC FLORENCE MEDICAL CENTER MUSC FLORENCE MEDICAL CENTER NAO MEDICAL NASHVILLE GENERAL HOSPITAL NASSAU UNIVERSITY MEDICAL CENTER NATHAN SMITH CLINIC NATIONAL CANCER INSTITUTE NATIONAL INSTITUTES OF HEALTH NEBRASKA MEDICINE NEIGHBORHOOD FAMILY PRACTICE NEW YORK PRESBYTERIAN BROOKLYN METHODIST HOSPITAL NEW YORK PRESBYTERIAN QUEENS NEWPORT HEALTH CENTER NGH NIDO CLINIC NORFOLK PUBLIC HEALTH DEPARTMENT NORTH COASTAL PUBLIC HEALTH CENTER NORTH HILLS FAMILY MEDICINE NORTH MEMORIAL HEALTH SPECIALTY CLINIC - MAPLE GROVE NORTH SHORE UNIVERSITY NORTH TEXAS INFECTIOUS DISEASES CONSULTANTS NORTH VISTA HOSPITAL NORTHERN NEVADA HOPES NORTHSIDE FAMILY MEDICINE AND URGENT CARE NORTHSIDE HOSPITAL NORTHSIDE HOSPITAL ATLANTA NORTHSIDE HOSPITAL GWINNETT NORTHWELL HEALTH ID NORTHWELL HEALTH NORTHSHORE UNIVERSITY HOSPITAL NORTHWEST COLORADO HEALTH NORTHWESTERN NORTHWESTERN ID CENTER NORTHWESTERN MEDICAL CENTER NORTHWESTERN MEDICINE NORTHWESTERN MEDICINE INFECTIOUS DISEASE CENTER NORTHWESTERN MEMORIAL HOSPITAL NOVANT HEALTH INFECTIOUS DISEASE SPECIALISTS NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER, CHARLOTTE NUVANCE HEALTH DANBURY NUVANCE HEALTH NORWALK NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE NYC HEALTH + HOSPITALS/CONEY ISLAND NYC HEALTH + HOSPITALS/QUEENS NYC HEALTH AND HOSPITALS NYC HHC WOODHULL HOSPITAL NYCHHC METROPOLITAN HOSPITAL NYDG INTEGRAL HEALTH AND WELLNESS NYU LANGONE NYU STUDENT HEALTH CENTER NYU STUDENT HEALTH CENTER OAKLAND PARK OCHSNER HEALTH OCMC O'CONNOR HOSPITAL OFFICE OF ALI HARAKE OFFICE OF EAMONN VITT MD OH SOUTH SMINOLE HOSPITAL OHIO HEALTH URGENT CARE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER OHIOHEALTH GRANDVIEW URGENT CARE OHIOHEALTH RIVERSIDE METHODIST HOSPITAL OHSU OHSU HOSPITAL OKLAHAMA STATE UNIVERSITY MEDICAL CENTER OLIVE VIEW MEDICAL CENTER OLYMPIA MEDICAL CENTER ON POINT MEDICAL GROUP ONE HEALTH ONE MEDICAL ONE MEDICAL - FASHION SQUARE, SCOTTSDALE ONE MEDICAL LA ONE MEDICAL, LOS ANGELES OPEN DOOR HEALTH OPEN HEALTH CARE CLINIC ORANGE COUNTY PUBLIC HEALTH STD CLINIC OREGON HEALTH AND SCIENCE UNIVERSITY ORLANDO HEALTH ORLANDO IMMUNOLOGY CENTER ORLANDO REGIONAL MEDICAL CENTER OSF ST FRANCIS MEDICAL CENTER OU HEALTH - OU MEDICAL CENTER OUR LADY OF THE LAKE RMC OUTER CAPE HEALTH SERVICES OUTPATIENT MOBILE CLINIC OVERLOOK MEDICAL CENTER - UNION CAMPUS PA DEPARTMENT OF HEALTH STI CLINIC PACIFIC OAKS MEDICAL GROUP PALMETTO GENERAL HOSPITAL PALO ALTO MEDICAL FOUNDATION PALO ALTO MEDICAL FOUNDATION PALOMAR HEALTH MEDICAL CENTER PARIS CARE CLINIC-SHRT PARK NICOLLET CLINIC PARKLAND HEALTH PARKVIEW REGIONAL MEDICAL CENTER PATIENT FIRST AT FAIRFAX PEACHTREE IMMEDIATE CARE - BRUNSWICK PEAKMED DIRECT PRIMARY CARE AT NORTHGATE PECONIC BAY MEDICAL CENTER PENN INSTITUTE FOR REHAB MEDICINE PENN MEDICINE PENN PRESBYTERIAN MEDICAL CENTER (PPMC) PENN STATE HEALTH HERSHEY MEDICAL CENTER PENNSYLVANIA HOSPITAL PENTUCKET MEDICAL INFECTIOUS DISEASE PERELMAN CENTER ADVANCED MEDICINE PERFORMING ARTS MEDICINE & FAMILY PRACTICE PETALUMA HEALTH CENTER PETER SHALIT MD & ASSOCIATES PETERSBURG HEALTH DEPARTMENT PHMC CONGRESO PHOENIX INDIAN MEDICAL CENTER PHYSICAN ONE URGENT CARE PHYSICIAN ONE URGENT CARE PIEDMONT ATLANTA HOSPITAL PIEDMONT COLUMBUS NORTHSIDE PIEDMONT COLUMBUS NORTHSIDE PIEDMONT FAYETTE PIEDMONT FAYETTE HOSPITAL PIEDMONT PHYSICIANS OF MIDTOWN PIEDMONT PLASTIC SURGERY AND DERMATOLOGY PIEDMONT ROCKDALE HOSPITAL PLANNED PARENTHOOD CALIFORNIA CENTRAL COAST PLANNED PARENTHOOD CENTRAL COAST THOUSAND OAKS POLYCLINIC POMONA VALLEY HOSPITA PONCE CLINIC PONDEROSA FAMILY CARE PORTER STATE SERVICE CENTER PORTLAND PUBLIC HEALTH CENTER PORTLAND PUBLIC HEALTH STD CLINIC POSITIVE IMPACT HEALTH CENTERS PR CONCRA PRARIE PARKWAY INTERNAL MEDICINE PRAVEENA SARMA, MD INF DISEASE CLINIC PRICE MEDICAL PRIDE MEDICAL PLLC PRIMA HEALTH UPSTATE PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT PRISM HEALTH NORTH TEXAS PRISMA HEALTH HILLCREST HOSPITAL PRISMA HEALTH RICHLAND HOSPITAL PRISMA HEALTH RICHLAND HOSPITAL PRIVATE PRACTICE PROMEDICA TOLEDO HOSPITAL PROVIDENCE ALASKA MEDICAL CENTER PROVIDENCE GATEWAY INTERNAL MEDICINE PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO PROVIDENCE SACRED HEART MEDICAL CENTER PROVIDENCE ST MARY MEDICAL CENTER PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY PUBLIC HEALTH CLINIC PUBLIC HEALTH SEATTLE & KING COUNTY SEXUAL HEALTH CLINIC PULASKI HEALTH UNIT - ARKANSAS DEPARTMENT OF HEALTH RAMSEY COUNTY PUBLIC HEALTH - CLINIC 555 RAPID ACCESS WELLNESS CLINIC RAPID CITY HOSPITAL RED DOOR CLINIC RED RIVER FAMILY PRACTICE REGIONAL ONE HEALTH REGIONS HOSPITAL RENOWN REGIONAL MEDICAL CENTER RENOWN URGENT CARE - RYLAND RESPONSIVE INFECTIOUS DISEASES SOLUTIONS RHODE ISLAND HOSPITAL RICHMOND UNIVERSITY MEDICAL CENTER RILEY CHILDREN'S HOSPITAL RIVERSIDE UNIVERSITY HEALTH SYSTEM RIVERTON HOSPITAL-HOLLADAY INSTACARE ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL ROBERTSON COUNTY HEALTH DEPARTMENT ROBLEY REX VA MEDICAL CENTER ROGER WILLIAMS MEDICAL CENTER ROGER WILLIAMS MEDICAL CENTER ROSE MEDICAL CENTER ROSS UNIVERSITY RUSH UNIVERSITY MEDICAL CENTER RUTGERS UNIVERSITY HOSPITAL RUTHERFORD COUNTY HEALTH DEPARTMENT RWJ BARNABAS RYAN CHELSEA CLINTON COMMUNITY HEALTH CENTER SACRED HEART MEDICAL CENTER RIVER BEND SAINT AGNES MEDICAL CENTER SAINT LUKE'S BOISE SAINT MARY MEDICAL CENTER SAINT PETER'S UNIVERSITY HOSPITAL SAINT RAPHAEL CAMPUS / YALE NEW HAVEN HEALTH SAINT VINCENTS HOSPITAL SALEM HEALTH HOSPITAL SALT LAKE CITY INSTACARE SAN ANTONIO INFECTIOUS DISEASES CONSULTANTS SAN ANTONIO METROPOLITAN HEALTH DISTRICT SAN DIEGO CENTRAL REGION PUBLIC HEALTH CENTER SAN FRANCISCO AIDS FOUNDATION - STRUT/MAGNET CLINIC SAN FRANCISCO CITY CLINIC SAN FRANCISCO VA HEALTH CARE SYSTEM SAN MATEO MEDICAL CENTER SAN MATEO MEDICAL CENTER SANFORD HEALTH SANITAS MEDICAL CENTER SANSUM CLINIC SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM SANTA CLARA VALLEY MEDICAL CENTER SANTA CLARA VALLEY MEDICAL CENTER MILPITAS SANTA MONICA SPECIALTIES SANTA ROSA COMMUNITY HEALTH SANTA ROSA COMMUNITY HEALTH SANTA ROSA MEMORIAL HOSPITAL SANTA ROSA MEMORIAL HOSPITAL SBH HEALTH SYSTEM SCPA IMMUNOLOGY SCRIPPS CLINIC SEA MAR CHC SEATTLE CHILDREN'S HOSPITAL SEATTLE INFECTIOUS DISEASE CLINIC SELECT SPECIALTY HOSPITAL - COLUMBUS SOUTH SENTARA NORTHERN VIRGINIA MEDICAL CENTER SENTARA OBICI HOSPITAL SENTARA VIRGINIA BEACH GENERAL HOSPITAL SF AIDS FOUNDATION SHARP CHULA VISTA EMERGENCY DEPARTMENT SHARP GROSSMONT HOSPITAL SHARP MEDICAL GROUP SHARP-REES STEALY SHASTA COMMUNITY HEALTH SHELBY COUNTY HEALTH DEPARTMENT SIERRA NEVADA RENO VA HOSPITAL SKY RIDGE MEDICAL CENTER SOHO HEALTH SOLE HEALTH MED CTR SOTO-ACOSTA RAUL OFFICE SOUTH AUSTIN MED CENTER SOUTH BALTIMORE COUNTY MEDICAL CENTER SOUTH MIAMI HOSPITAL SOUTH REGION PUBLIC HEALTH CENTER SOUTH SEMINOLE HOSPITAL SOUTH SHORE HEALTH SOUTHAMPTON HEALTHCARE SOUTHERN NEVADA HEALTH SOUTHERN REGIONAL MEDICAL CENTER SOUTHWEST CENTER FOR HIV/AIDS SOUTHWEST COMMUNITY HEALTH CENTER SOUTHWEST MEDICAL ASSOCIATES NORTH TENAYA URGENT CARE SOUTHWEST MEDICAL ASSOCIATES URGENT CARE SOUTHWEST MEDICAL S. EASTERN URGENT CARE SPECTRUM MEDICAL CARE CENTER SRS URGENT CARE SSM HEALTH DEAN MEDICAL GROUP-STOUGHTON CLINIC ST BERNARDS ST ELIZABETH HOSPITAL EDGEWOOD KY ST LUKE'S THE WOODLANDS HOSPITAL ST VINCENT MEDICAL CENTER, BRIDGEPORT, CT ST VINCENTS HOSPITAL ST. ANTHONY'S HOSPITAL ST. BARNABAS HOSPITAL ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN ST. ELIZABETH YOUNGSTOWN ST. JOHN'S COMMUNITY HEALTH ST. JOHN'S RIVERSIDE HOSPITAL ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER ST. JUDE CHILDREN'S RESEARCH HOSPITAL ST. LUKES FAMILY MEDICINE-EAGLE ST. MARY'S OF NAZARETH EMERGENCY DEPARTMENT ST. ROSE DOMINICAN HOSPITAL ST. THOMAS COMMUNITY HEALTH CENTER ST. VINCENT ST.LOUIS UNIVERSITY HOSPITAL STANFORD HEALTHCARE STARMED STONEWALL MEDICAL CENTER BORREGO HEALTH STONY BROOK MEDICINE UNIVERSITY HOSPITAL STORMONT VAIL HOSPITAL STROGER HOSPITAL STRONG MEDICAL MEMORIAL / UNIVERSITY OF ROCHESTER MEDICAL CENTER SUITE 401 MEDICAL - PHILLIP MUSIKANTH SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT SULLIVAN DERMATOLOGY SULLIVAN STREET MEDICAL SUMMA HEALTH SUMMIT COUNTY PUBLIC HEALTH SUMTER CO. HEALTH DEPT. SUN RIVER HEALTH SUNRISE HOSPITAL SUNY DOWNSTATE SUNY UPSTATE MEDICAL UNIVERSITY SUTTER HEALTH / EAST BAY AIDS CENTER SUTTER HEALTH MEMORIAL MEDICAL CENTER SUTTER HEALTH MILLS SUTTER MEDICAL CENTER SACRAMENTO SUTTER ROSEVILLE MEDICAL CENTER SWEDISH MEDICAL CENTER TACOMA GENERAL HOSPITAL TAMPA GENERAL HOSPITAL TANASBOURNE IMMEDIATE CARE TANDEM HEALTH TARZANA TREATMENT CENTERS, INC RESEDA TEMPLE UNIVERSITY HOSPITAL TENARLY PEDIATRICS TENNESSEE VALLEY HEALTHCARE SYSTEM TENNESSEE VALLEY HEALTHCARE SYSTEM TEPEYAC COMMUNITY HEALTH CENTER TEXAS DEPARTMENT OF STATE HEALTH SERVICES TEXAS HEALTH FORT WORTH HOSPITAL TEXAS HEALTH RESOURCES DALLAS- INFECTIOUS CARE TEXAS HEALTH RESOURCES DALLAS- INFECTIOUS CARE TEXAS MEDCLINIC URGENT CARE THACKER AND THOMPSON THE BROOKLYN HOSPITAL CENTER THE DOCTOR LA THE DOCTORS OFFICE THE EVERETT CLINIC THE RYAN WHITE WELLNESS CENTER THE RYAN WHITE WELLNESS CENTER THE SPOT AT ST. LOUIS CHILDREN'S HOSPITAL THOMAS JEFFERSON UNIVERSITY HOSPITAL THRIVE ALABAMA TIBOR RUBIN VAMC, LONG BEACH TO HELP EVERYONE HEALTH+WELLNESS TOLAN PARK TOTAL DERMATOLOGY CARE CENTER TRINITY HEALTH SAINT MARY'S TRIPLE O MEDICAL SERVICES TRIPLER ARMY MEDICAL CENTER TUCSON MEDICAL CENTER TUFTS MEDICAL CENTER INFECTIOUS DISEASES CLINIC TULANE UNIVERSITY TULANE UNIVERSITY UAB HUNTSVILLE UC DAVIS MEDICAL CENTER UC DAVIS STUDENT HEALTH AND COUNSELING SERVICES UC SAN DIEGO HEALTH/OWEN CLINIC UC SAN DIEGO HILLCREST HOSPITAL / UC SAN DIEGO HEALTH MEDICAL CENTER UCHC URGENT CARE STORRS, CT UCHEALTH LOVELAND INFECTIOUS DISEASE CLINIC UCHEALTH MEMORIAL CENTRAL UCI MEDICAL CENTER UCLA UCLA INF DIS CLINIC UCSF FRESNO UCSF PARNASSUS INFECTIOUS DISEASE CLINIC UCSF WARD 86/POSITIVE HEALTH PROGRAM UCSF ZUCKERBERG SAN FRANCISCO GENERAL UF HEALTH JACKSONVILLE UF HEALTH SHANDS HOSPITAL UF SHANDS UH AHUJA MEDICAL CENTER UHNJ UHS BINGHAMTON GENERAL HOSPITAL UM CAPITAL REGION MEDICAL CENTER UMASS MEMORIAL HEALTH CARE UMC WELLNESS CENTER UNION MEMORIAL HOSPITAL UNITED HOSPITAL UNITY POINT UNIV OF WASHINGTON MEDICAL CENTER UNIVERSITY DISTRICT HOSPITAL, RECINTO DE CIENCIAS MEDICAS UNIVERSITY HEALTH TRUMAN MEDICAL CENTER UNIVERSITY HOSPITAL UNIVERSITY MEDICAL CENTER UNIVERSITY OF ALABAMA AT BIRMINGHAM UNIVERSITY OF ALABAMA BIRMINGHAM - 1917 CLINIC UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF CALIFORNIA SAN FRANCISCO UNIVERSITY OF CHICAGO MEDICINE UNIVERSITY OF CINCINNATI UNIVERSITY OF COLORADO HOSPITAL UNIVERSITY OF FLORIDA, SHANDS HOSPITAL UNIVERSITY OF ILLINOIS HEALTH UNIVERSITY OF IOWA HOSPITAL AND CLINICS UNIVERSITY OF KANSAS MED CTR UNIVERSITY OF KENTUCKY HEALTHCARE BLUEGRASS CARE CLINIC UNIVERSITY OF MARYLAND UNIVERSITY OF MIAMI HOSPITAL UNIVERSITY OF MIAMI RAPID ACCESS WELLNESS CLINIC UNIVERSITY OF MIAMI STUDENT HEALTH SERVICE UNIVERSITY OF MIAMI SYLVESTER COMPREHENSIVE CANCER CENTER UNIVERSITY OF MICHIGAN UNIVERSITY OF MINNESOTA MEDICAL CENTER UNIVERSITY OF MISSISSIPPI MEDICAL CENTER UNIVERSITY OF MISSOURI HEALTH CARE UNIVERSITY OF NEBRASKA MEDICAL CENTER UNIVERSITY OF NORTH CAROLINA HEALTH UNIVERSITY OF PITTSBURGH MEDICAL CENTER UNIVERSITY OF TEXAS UNIVERSITY OF TEXAS HEALTH SAN ANTONIO UNIVERSITY OF TEXAS MEDICAL BRANCH UNIVERSITY OF TEXAS SOUTHWESTERN UNIVERSITY OF TOLEDO MEDICAL CENTER UNIVERSITY OF UTAH UNIVERSITY OF VIRGINIA UNIVERSITY OF WASHINGTON MEDICAL CENTER - NORTHWEST UNIVERSITY OF WASHINGTON MEDICAL CENTER MONTLAKE UNM TRUMAN HEALTH UPTOWN PHYSICIANS GROUP URGENTMED URGENT CARE CENTER UTAH COUNTY HEALTH DEPARTMENT UW HEALTH UNIVERSITY HOSPITAL UW MEDICINE HARBORVIEW MADISON SNOHOMISH CLINIC UW MEDICINE HARBORVIEW MEDICAL CENTER UWC MEMORIAL HOSPITAL UWMC VIROLOGY VA BOSTON HEALTHCARE SYSTEM VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM VA CT HEALTHCARE SYSTEM VA EASTERN COLORADO HEALTHCARE SYSTEM VA GREATER LOS ANGELES HEALTHCARE SYSTEM VA LOMA LINDA VA LONG BEACH HEALTHCARE SYSTEM VA MATHER MEDICAL CENTER VA NORTH TEXAS HEALTHCARE SYSTEM VA PALO ALTO VA PALO ALTO HEALTH CARE SYSTEM VA PALO ALTO HEALTH CARE SYSTEM VA PALO ALTO HEALTH CARE SYSTEM VA PALO ALTO HEALTH CARE SYSTEM VA PITTSBURGH HEALTHCARE SYSTEM VA WHITE RIVER JUNCTION MEDICAL CENTER VA-EASTERN COLORADO HEALTHCARE SYSTEM VAIL HEALTH- COLORADO MOUNTAIN MEDICAL VALLEY HEALTH CENTER- MOORPARK CLINIC VALLEY HOSPITAL VALLEY MEDICAL CENTER VALLEYWISE COMMUNITY HEALTH CENTER VALLEYWISE HEALTHCARE MCDOWELL VANDERBILT UNIVERSITY VASSAR BROTHERS MEDICAL CENTER VENTURA COUNTY MEDICAL CENTER VETERANS ADMINISTRATION WESTERN NEW YORK HEALTHCARE SYSTEM VETERANS AFFAIRS HEALTH CARE SYSTEM PALO ALTO VETERANS MEDICAL CENTER ORLANDO VILLAGE MEDICAL PRIMARY CARE VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER VIRGINIA HOSPITAL CENTER VIRGINIA MASON FRANCISCAN HEALTH VIRGINIA MASON MEDICAL CENTER VIRTUA WILLINGBORO HOSPITAL VIRTUAL CARE VISTA COMMUNITY CLINIC VISTA MEDICAL CENTER - EAST VIVE CLINIC VIVENT HEALTH VIVENT HEALTH CLINIC VOLUSIA COUNTY HEALTH DEPARTMENT WAKE COUNTY HHS WAKEMED HEALTH AND HOSPITALS WALTER L AUMENT FAMILY HEALTH CENTER WALTER REED WASHINGTON DC VETERANS AFFAIRS MEDICAL CENTER WASHINGTON HOSPITAL CENTER WASHINGTON UNIVERSITY WASHINGTON UNIVERSITY / BARNES JEWISH WASHINGTON UNIVERSITY ST. LOUIS INFECTIOUS DISEASES CLINIC WATERBURY HOSPITAL WATSONVILLE COMMUNITY HOSPITAL WAYNE HEALTH/WAYNE STATE UNIVERSITY WAYNE PEDIATRICS WEILL CORNELL MEDICINE WELLMED AT LIVE OAK WELLNESS HOME AT NORTHSTAR WELLNESS HOME ON HALSTED WELLSTAR KENNESTONE WELLSTAR MEDICAL GROUP CORPORATE MEDICINE @ TIP TOP WELLSTAR PAULDING HOSPITAL WESLEY HEALTH CENTER WESLEY LONG HOSPITAL WEST BERKELEY FAMILY PRACTICE, LIFELONG MEDICAL CARE WEST CECIL HEALTH CENTER WEST COAST PRIMARY CARE WEST COUNTY HEALTH CENTER WEST KENDAL BAPTIST HOSPITAL WESTCHESTER MEDICAL CENTER WESTERN INFECTIOUS DISEASE CONSULTANTS WESTPALM COUNTY JAIL WESTSIDE FAMILY MEDICINE WHATCOM COUNTY HEALTH DEPARTMENT WHITE MEMORIAL COMMUNITY HEALTH CENTER WHITE PLAINS HOSPITAL WHITMAN WALKER HEALTH WHOLE FAMILY HEALTH CENTER WILKES BARRE VA MEDICAL CENTER WILLIAM S MIDDLETON MEMORIAL VETERANS HOSPITAL WILLIAMS MEDICAL CENTER WILLIAMSON COUNTIES + CITIES HEALTH DISTRICT WILSON COUNTY HEALTH DEPARTMENT WINCHESTER HOSPITAL WW MED SPECIALTY SUITES XPRESS URGENT CARE YALE NEW HAVEN HOSPITAL YAMPA VALLEY YOUR HEALTH AND WELLNESS ZION HEALTHCARE LLC JM MEDICAL AND DENTAL
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6) Alternative facility name (if applicable )
7) Name of the health system (if applicable)
8) Indicate if facility is a federal entity
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9)
10) City where the facility is located
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11) U.S. state or territory where the facility is located
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13) How many additional staff's work email addresses would you like to add? (Optional)
Additional staff contacts included will receive a registry confirmation email for a verification step to gain access to the electronic TPOXX IND forms (e.g., required Patient Intake and Clinical Outcome forms).
14) Does your facility have an institutional or designated pharmacy managing TPOXX dispensing ?
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15)
First and Last Name
16) Pharmacy contact email address
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