Home Page - IHSEDR

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U.S. Department of Health and Human Services

Indian Health Service The Federal Health Program for American Indians and Alaska Natives

EDR Management Admin Tool

Register

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General Site Information

Area:

Service Unit:

Site:

Satellite Site:

Dental Clinic Main Phone:

Date of On-Site/Remote Visit:

ITU:

ASUFAC:

ASUFAC Notes:

Facility Type:

DXE Support Type:

Small

Address:

City:

State:

Zip:

Attn to:

Time Zone:

Latitude:

Longitude:

Dentrix Customer ID:

Annual Support Renewal:

Shipping Loading Dock:

Yes No

Shipping Address if Different:

Yes No

Website:

Shipping Information

Shipping Site Name:

Shipping Address:

Shipping City:

Shipping State:

Attn to:

Zip:

Dental Clinic Shipping Phone:

Implementation Id: