Montana Health Workforce Services (WIM) provides health care practices and workforce researchers with data regarding the distribution of Wyoming, Idaho and Montana’s health workforce. WIM is currently reviewing capacity of providers to take new patients and working to build a new public directory of providers who see special needs patients. We request your help by submitting this form to confirm your providers (please add or cross out names as necessary). An electronic version is available at wimtracking.com/submit.

Key 1 – ADHD   2 – Addiction   3 – Anorexia Nervosa   4 – Autism Spectrum Disorder   5 – Celiac Disease   6 – Cerebral Palsy   7 – Cystic Fibrosis   8 – Down Syndrome   9 – Epilepsy   10 – Fetal Alcohol Syndrome   11 – Fragile X Syndrome   12 – Hydrocephalus   13 – Muscular Dystrophy   14 – Multiple Sclerosis   15 – Obesity   16 – Paralysis   17 – Skeletal Dysplasia   18 – Spina Bifida   19 – Tourette Syndrome   20 – Other

Please return completed form to: WIM Tracking PO Box 302 Townsend, MT 59644 or [email protected]. Direct questions to Jena Smith (406) 640-1230 or [email protected].