Please upload your practitioner registration form below. Quarterly reports OR “As Needed” updates can be uploaded to this portal. The form must be completely filled out, or it may be denied. Please make sure to indicate whether the practitioner is new, deleted or continuing. For quarterly reports, please indicate the number of hours of the ICD trainings the practitioner has completed at the time of the report.

PLEASE SAVE YOUR REGISTRATION FORM FOR FURTHER USE. Integrated COD staff cannot guarantee capability of providing you with your organization’s form.

You can download the form at www.oregon.gov/icd

You will receive notification of approval or denial of submission within ten days. Denial notifications will include explanation for denial.