Providers Home - Beacon Health Options Maryland 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Client MRN and selecting whether this is an Initial Registration or Annual Update. Fill in the Provider Name and MD Name as required.
3. Complete the CLIENT NAME section with the client's current last name, first name, middle name, and any aliases. Ensure you also enter the Date of Birth and County of Birth accurately.
4. In the ADDRESS section, provide the street address, city, state, and zip code. Select the appropriate Address Type from the options provided.
5. Fill in TELEPHONE details including Telephone Number and type (Cell, Home, etc.).
6. Complete DEMOGRAPHICS by selecting gender, marital status, number of dependents under and over 18, and residential living arrangement.
7. Continue filling out sections for Occupation Type, Employment Status, Veteran’s Status, Hispanic Origin, Race, Primary Language, Preferred Language, Education details, and Emergency Contact information.
8. Finally, ensure all information is accurate before signing at the bottom of the form. Use our platform's features to save your progress or submit directly.

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