OPRA Enrollment Form and Instructions

Included below is a link to the Medicaid Enrollment Form for those who only Order-Prescribe-Refer-Attend (OPRA) for Early Intervention services within the State of New York, regardless of where the OPRA provider is located. Also included is a link to detailed instructions for completing the enrollment form. Please read the instructions prior to completing the form to enroll, revalidate, or reactivate with Medicaid.