(a) Data shall be submitted using the Department's online submission system to file or submit each report. The following information must be included: the facility name, the unique identification number specified in Section 97210, the beginning and ending dates of the report period, the number of records in the report and the following statement of certification:

(b) Reporting facilities with an approved exemption to submit records using a method other than the Department's online submission system must submit the following information: facility name, the unique identification number specified in Section 97210, the data type of the report, the report period of the records submitted, the number of records in the report, the medium of accompanying records, the certification language as provided in (a) above, with a signature of the authorized representative of the facility and contact information. The information shall accompany the report.

(c) A facility's administrator may designate User Account Administrators. For each User Account Administrator there must be a signed facility User Account Administrator Agreement form (HCAI-OIS-773 Rev. August 2023), hereby incorporated by reference, submitted to the Department.

(d) Forms may be obtained from the Department of Health Care Access and Information web site at www.hcai.ca.gov or by contacting the Department's Patient Data Program at (916) 326-3935.