NC DHHS
ELR Registration Information Update Form

Health care facilities and health systems in any stage of ELR onboarding with NC DHHS may use this form to update their registration information.

Please provide your first and last name. *

Please enter in ALL CAPS

What health care organization are you providing an update for? *

Please enter in ALL CAPS

Please provide your email address. *

Please enter in ALL CAPS (i.e., EXAMPLE@DHHS.NC.GOV)

Please provide a direct phone number. *

Phone

What information do you need to update? *

*

Send me a copy of my responses