Welcome to the Physician Acknowledgement
Monitoring Online Submission Form.

This form will allow you to upload and submit your Physician Report and Acknowledgement Statements to Acentra Health to meet their obligation. Please provide the details below. Fields marked with an asterisk (*) are required. You will not be able to edit this screen once your request is submitted. When you are finished, click Submit. All information provided will be handled securely by our team.

Instructions:

1. Before you start uploading your documents, Acentra Health recommends scanning acknowledgement forms into a single PDF document for upload (to eliminate the need to upload multiple files). This is not a requirement.
2. Click on "Choose File." 
3. Browse on your computer to locate the file. Click on the file you want to upload.
   File Upload Limit: Please note that files larger than 20 MB will not be accepted by the system. Ensure each file is 20 MB or smaller before uploading.
4. Click on "Upload" to upload the document.
5. To add more documents, return to step 1.
6. After you have uploaded your Physician Report and all Physician Statements, click "Submit."