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J-1 Visa Waiver Program Patient Activity Report

The Patient Activity Reporting form is due each January 15th and July 15th showing payer mix data for the prior six month period, i.e.: data for January – June is due July 15th and data for July – December is due January 15th.  A copy of the form can be found on the right hand side of this page.

Please e-mail the completed form to HealthPolicy@odh.ohio.gov.