Provider Surveys for Medical, Dental, and Mental Health Professionals

The federal Shortage Designation Branch requires specific data to be submitted in applications requesting designation of an area or population group as a Health Professional Shortage Area (HPSA) or Medically Underserved Area/Population (MUA/P). The required information consists largely of primary care providers names, specialties, office locations, hours per week in patient care activities, information on the provider's patient population, and information on other activities the provider might be engaged in outside of patient care. 

In reviewing the designation status of areas within Michigan, the Michigan Department of Health and Human Services collects data primarily through phone surveys of provider offices. In the case of primary medical care physicians, data is also collected through the Michigan Survey of Physicians distributed to physicians with their license renewal information. The documents below are the current versions of the surveys used to collect shortage designation data. Reviewing these surveys should assist in familiarizing you with the information required for evaluating shortage designations. Interested providers and offices may also feel free to proactively complete surveys and return them to the Michigan Department of Health and Human Services.

For primary medical care HPSAs and for MUA/P designations, the following survey is used:
Primary Medical Care Physician Survey Form 

For mental health care HPSA designations, the following survey is used:
Mental Health Care Provider Survey Form 

For dental health care HPSA designation, the following survey is used:
Dental Health Care Provider Survey Form 

Please return completed surveys to:

Miguelina Carela-Garcia
Fax: (517) 284-4993