You may self-report by doing one of the following:
- Print the form and fax to a confidential fax number 515-242-0155 or mail to IPHP, 400 SW 8th, Suite C, Des Moines, IA 50309-4686.
- Contacting Amy Van Maanen, Program Coordinator (515) 281-6006.
(You may leave a confidential message on voice mail); or
- Email (email@example.com)