Training Sign Up Step 1 of 3 33% Tell Us Who You AreIdentify yourself by filling out the following information:Name(Required) First Last Email Address(Required) Enter Email Confirm Email Select Your User Role(Required)Select Your User Role *Provider / SupplierQuality Improvement OrganizationAccrediting OrganizationHHS Employee / ContractorAdvocacy GroupEducator / Author / ResearcherOther Provider / SupplierProvider / Supplier Type(Required)Provider / Supplier Type *Acute Care HospitalsASC - Ambulatory Surgical CenterCAH - Critical Access HospitalCLIA / LabsCMHC - Community Mental Health CenterCORF - Comprehensive Outpatient Rehabilitation FacilityESRD - End Stage Renal Disease FacilityFQHC - Federally Qualified Health CenterHHA - Home Health AgencyHOSP - HospitalHSPC - HospiceICF / IID - Intermediate Care Facilities for Individuals with Intellectual DisabilitiesOPO - Organ Procurement OrganizationsOT / SP - Occupational Therapy / Speech PathologyPACE - Programs of All-Inclusive Care for the ElderlyPRTF - Psychiatric Residential Treatment FacilityPSYC - Psychiatric HospitalPTF - Physical Therapy FacilityRHC - Rural Health CenterRNHI - Religious Nonmedical Healthcare InstitutionsSNF / NF - Skilled Nursing Facility / Nursing FacilitiesSwing-Bed HospitalsTRAN - Organ Transplant / Except KidneyXRAY - Portable X-Ray ServicesQuality Improvement OrganizationQIO Name(Required)QIO Name *Area 1 - LivantaArea 2 - KEPROArea 3 - KEPROArea 4 - KEPROArea 5 - LivantaAlliant-Georgia Medical Care FoundationAtlantic Quality Improvement Networkatom AllianceGreat Plains Quality Innovation NetworkHealth Services Advisory GroupHealthcentric AdvisorsHealthInsightLake Superior Quality Innovation NetworkMountain Pacific Quality Health FoundationQualis HealthQuality Insights Quality Innovation NetworkTelligenTMFVHQCAccrediting OrganizationAO Type(Required)AO Type *CLIACLIA (EXEMPT STATES)Non-CLIAAO Name(Required)AO Name *AABBAccreditation Association for Hospitals and Health Systems / Healthcare Facilities Accreditation Program (AAHHS / HFAP)American Association for Laboratory AccreditationAmerican Society for Histocompatibility and ImmunogeneticsCOLACollege of American PathologistsJoint CommissionAO Name(Required)AO Name *Clinical Laboratory Evaluation Program State of New York Department of HealthHSQA/IIO - Laboratory Quality AssuranceAO Name(Required)AO Name *Accreditation Association for Ambulatory Health Care (AAAHC)Accreditation Commission for Health Care, Inc (ACHC)American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)American Osteopathic Association / Healthcare Facilities Accreditation Program (HFAP)Center for Improvement in Healthcare Quality (CIHQ)Community Health Accreditation Partner (CHAP)DNV GL - Healthcare (DNV GL)National Dialysis Accreditation Commission (NDAC)The Compliance Team (TCT)The Joint Commission (TJC)HHS Employee/ContractorHHS Agency(Required)HHS Agency *Administration for Children and Families (ACF)Administration for Community Living (ACL)Agency for Healthcare Research and Quality (AHRQ)Agency for Toxic Substances and Disease Registry (ATSDR)Assistant Secretary for Administration (ASA)Assistant Secretary for Financial Resources (ASFR)Assistant Secretary for Health (ASH)Assistant Secretary for Legislation (ASL)Assistant Secretary for Planning and Evaluation (ASPE)Assistant Secretary for Preparedness and Response (ASPR)Assistant Secretary for Public Affairs (ASPA)Center for Faith-Based and Neighborhood Partnerships (CFBNP)Centers for Disease Control and Prevention (CDC)Centers for Medicare & Medicaid Services (CMS)Departmental Appeals Board (DAB)Food and Drug Administration (FDA)Health Resources and Services Administration (HRSA)Immediate Office of the Secretary (IOS)Indian Health Service (IHS)National Institutes of Health (NIH)Office for Civil Rights (OCR)Office of Global Affairs (OGA)Office of Inspector General (OIG)Office of Intergovernmental and External Affairs (IEA)Office of Medicare Hearings and Appeals (OMHA)Office of the Chief Technology Officer (CTO)Office of the General Counsel (OGC)Office of the National Coordinator for Health Information Technology (ONC)Substance Abuse and Mental Health Services Administration (SAMHSA)Advocacy GroupAdvocacy Group Name(Required)Advocacy Group Name *Administration for Children and Families (ACF)Administration for Community Living (ACL)Agency for Healthcare Research and Quality (AHRQ)Agency for Toxic Substances and Disease Registry (ATSDR)American Medical Student AssociationAmerican Nurses AssociationCalifornia Nurses Association/National Nurses Organizing CommitteeCampaign for Better Health CareFamilies USAHealth Care for America NOW!Healthcare-NOW!Medicare Rights CenterNational Coalition on Health CareNational Physicians AlliancePennsylvania Medical SocietyPhysicians for a National Health ProgramShoutAmericaUniversal Health Care Foundation of ConnecticutWe Can Do Better (formerly Archimedes Movement)Educator/Author/ResearcherState(Required)State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificOrganization Name(Required) If you have taken this course within the last 12 months you can look up your certification on the site listed (https://www.intelycare.com/covid-19/illinois-training-cms/), print, and upload it to On Point Care. 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