Provider Directory Report

Agency Type

Select the type of agency included in the report.

Agency Available

Select the agency(ies) to be included in this report, then click Add>>.

Agency Selected

This field displays the agency(ies) selected from the previous field. At least one agency must be selected.

Provider ID

To generate a report for a specific provider, enter the provider's system-generated ID number. Leave the other parameter fields blank.

Zip Codes Available

Enter the zip code(s) to be included in this report, then click Add>>.

Zip Codes Selected

This field displays the zip code(s) selected in the previous field.

Provider Status

Select the status of providers to be included in this report.

Home Study Assessor

Select the name of the home study assessor whose providers are included in this report.

Effective Date

Enter the effective date of the provider records. Use the format MM/DD/YYYY.