• SSC Ticket Submission

    The minimum necessary standard imposed under HIPAA requires covered entities to share the minimum necessary information with their business associates. Please include in this form the minimum necessary information for us to help answer your questions. Information such as name, date of birth, address of your patients or clients is not necessary and should not be included.
  • Please enter a number from 0 to 15.
  • MedicationDosage 
    Click the + symbol to add additional medications.
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    Max. file size: 4 MB.