Click below to download the EIDR request form and sample form for Nursing Home and Adult Day Health Care facilities.
Please submit completed request form for Nursing Home and Adult Day Health Care facilities to Mary Mason via email at email@example.com . Contact Mary with questions or requests for information at (225) 342-6116.
For EIDRs for ICF/IIDs, contact Enrika Lacour at firstname.lastname@example.org or (318) 487-5006..
For EIDRs for Hospitals, Hospital Based Rural Health Clinics, Free Standing Psych and Hospital Distinct Part Psych, contact Tizi Robinson at email@example.com or (225) 219-4285.