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Get Aries User Registration Form ( Cdph 8692 ) - California ... - Cdph Ca
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How to fill out the ARIES User Registration Form (CDPH 8692) - California online
The ARIES User Registration Form (CDPH 8692) is essential for users who require access to the ARIES system within the California Department of Public Health. This guide will provide you with a clear, step-by-step approach to accurately complete the form online.
Follow the steps to successfully fill out your registration form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the 'Contractor Information' section, provide your agency or provider name. If applicable, include the site name, address, city, and zip code.
- As an authorized agency representative, you will need to certify the user's employment status. Clearly print your name, provide your signature and the date.
- In the 'User Information' section, fill in the user's first name, last name, phone number, email, job title, and the number of computers they will use to access ARIES.
- Check all applicable ARIES application names: ARIES Client, ARIES Import, and ARIES Report/Export. If the ARIES Client is checked, specify the User Group Role.
- The user must sign the form, acknowledging their awareness of confidentiality requirements for Protected Health Information (PHI) and compliance with guidelines related to HIPAA.
- If applicable, complete the EMA approval section by including the printed name, signature, and date.
- Once all sections are filled out, save your changes, and consider downloading, printing, or sharing the form as needed.
Begin your online registration by filling out the ARIES User Registration Form today.
To contact the California Department of Public Health's Licensing and Certification division, you can find the specific phone number on their website. They handle inquiries related to licensing, including those tied to the ARIES User Registration Form (CDPH 8692). Their team can assist you with any questions regarding your certification status.
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