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How to Submit a Statement

If you are the subject of a report, you may add or edit a statement at anytime. The subject statement is your opportunity provide additional information you would like included with the report. However, you cannot modify, correct or void the report—only the reporting organization listed in Section A of the report may do so.

Your subject statement becomes part of the report and remains with the report unless you edit or remove it. The statement is sent to the reporting organization, all querying organizations who received a copy of the report within the past 3 years, and is included in future query responses. A statement must not include links (URLs) to websites, names of individuals, addresses, phone numbers, or any other personally identifiable information. If such information is discovered, we will redact it. Subject statements may characterize individuals in terms of their relationships (e.g., the patient, the attending physician).

Note: The system will time out after 60 minutes. You may want to write the statement elsewhere and then paste it into the Subject Statement section.

Submit a Statement

  1. On the home page, select Sign in to View Your Report.
  2. On the Sign In with a Report Number page, enter the report number and password, then select Sign In.
    Note: If you are signing into your report for the first time, use the report number and password on the notification letter.
  3. Read the information on the Rules of Behavior page, check the box to acknowledge the rules, and select Continue.
  4. On the Practitioner Identification page, enter your date of birth and your SSN or ITIN, then select Continue.
  5. On the Report Response Options page, select Add, Edit, or Withdraw a statement or dispute.
  6. Read the Subject Statement and Dispute page carefully. You can add a statement of up to 4,000 characters in the Subject Statement section.
    Note: We will redact any personally identifiable information, such as names or phone numbers. You may characterize individuals in terms of their relationships (e.g., the patient, the attending physician).
  7. Complete the Certification section (your name, title, and phone number) and submit.
  8. On the Subject Statement and Dispute Status page, select View Report to view and save a PDF of the report.