Telehealth and Telemedicine Registration Instructions

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1. Entity representative can submit the Telemedicine and Telehealth applications at https://dohlicensing.nj.gov, by clicking on Telehealth and Telemedicine option under Facility Licensing & Inspections section. 
     NOTE: Please use the link: https://dohlicensing.nj.gov/telehealthtelemedicine/  to directly access Telehealth Registry Instructions page.
    

2. On the instructions page users will have an option to initiate the Initial registration application by clicking on Initial Application Registration and Payment hyperlink.

     
       
       Please note any field with an * is required/mandatory field to be filled. 

3. Upon clicking, the user will get redirected to the CN 25 form as shown below.   User will fill in all the details on the CN-25 form and click on  the Next to  move to the Payment and Certification page.
 
    
      
      NOTE: If the Entity address is not from NJ, then the registered agent address becomes mandatory and must be a NJ address.
       If the Entity address is from NJ, then the Registered agent isn’t mandatory. When the  Registered agent details are not updated, these are the following outcomes:

• If there is no registered agent details available as part of the application, then the mailing address at the application level will be blank and also no contact record will be created for registered agent.
• If there is no registered agent details available as part of the application, then the mailing address at the facility level will also be blank.
• If there is no registered agent details available as part of the application, then the registered agent details at the company level will also be blank.

        Please note any field with an * is required/mandatory field to be filled. 

4. The user will have an option to make an online payment for the registration application by clicking on the Pay Now   button.
   

5.  User will go into the e-payments page where he/she needs to fill in the basic details and select the type of service if Electronic Check Payment or Credit Card Payment. Then the user needs to to click on Continue. 
     

        Please note any field with an * is required/mandatory field to be filled. 
 

If Electronic Check Payment:

6. Once you click Continue, the system will display a preview page. Please verify that the information displayed is correct. If correct, click on Confirm If the information is incorrect, click on Edit to make the corrections.
 

    
 

7. Clicking Confirm will take you the payment information page. On this page, please answer the question and then select your account type, either “Checking” or “Savings”. 
    Then proceed to enter your bank information and click on Submit to proceed with the payment process or click on Reset to clear the page and start over.

   
    

8. After clicking on Submit, you will be asked to verify the information and to agree to allow the State of New Jersey to debit the amount you see on the page.
    If the information is correct, click on Submit Echeck to submit the payment.   Once the payment is processed the system will redirect you back to Payment and Certification page. .

    

 


If Credit Card Payment:

       NOTE: There is a service charge/convenience fee for facilities that choose the credit card payment option.
       Customer credit card information is not retained by State of New Jersey (Department of Health).
10. Once you click Continue , the system will display a preview page. Please verify that the information displayed is correct. If correct, click on Confirm If the information is incorrect, click on Edit to make the corrections.

       

11. Please verify the details on the screen. If everything looks good, click on I Agree to the Terms to proceed with the payment process.
      

12. After agreeing to the credit card disclaimer, you will be directed to the Payment Management Services page. The page should be auto filled with your Billing Information. If it is not, then please fill out the requested information.
      NOTE: There is a service charge/convenience fee for facilities that choose the credit card payment option. Customer credit card information is not retained by State of New Jersey (Department of Health).

     
     

       Please note any field with an * is required/mandatory field to be filled. 
 

13. Once the customer billing information is filled/updated please scroll down the page to add the credit card information. Click on Continue  to move forward with the payment or you can click Cancel Payment to cancel the payment process.

     

14. After clicking on Continue, you will be guided to a preview/verification page. Please make sure all information shown on screen is correct.
      If anything is not accurate, you can click on Edit to update the information and then click on Make Payment to process the payment or you can click Cancel Payment to cancel payment procedure.
      Once the payment is processed the system will redirect you back to Payment and Certification page.

15. Here the entity representative name, title and entity name will be pre-populated from the CN -25 form. The user will have an option to check the box to certify the information. Please click on Next  to go to Review & Submit section.
      

16. In the Review & Submit  section, the user can review the information and submit the application. When clicked on Submit, the portal will allow the user to print a summary of what she/he has submitted.
       NOTE: Once submission is done on, an email notification is sent to the user.
        
        
       
17. Below is the Print Summary.
       

18.  Once the entity representative submits the application, they will receive an invitation on the email address they mentioned on the CN 25 form to sign up by redeeming the invitation code.
       

19. Click on Sign In.
       

20.  Upon clicking, you will be directed to the Sign-In page. Here, please fill in your username and password and click on Sign In, you will be directed to your account.