Get Chcsahlta Account Creation Fillable Form

Completing the Chcsahlta Account Creation Fillable Form online is an essential step for gaining access to critical patient information systems. This guide provides clear, step-by-step instructions to ensure that you fill out the form accurately and efficiently.

Follow the steps to successfully complete the form:

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling out the name section with your last name, first name, and middle initial. This is crucial for proper identification.
3. Enter your date of birth in the format specified, ensuring accuracy for access verification.
4. Select your gender by marking the appropriate option provided (M or F).
5. Input your rank or rate, along with your duty station to specify your current assignment.
6. Indicate your work area or clinic. Make sure to select the correct option from the list provided.
7. Choose your role by marking one of the available options such as Provider, Nurse, Support Tech, or Clerk, or specify another role if applicable.
8. If applicable, provide your provider specialty and EDIPI number specifically for reservists.
9. Select the relevant areas you will need access to by checking the appropriate boxes for CHCS, AHLTA, and Essentris.
10. Complete the statement of accountability by printing your name in the designated area as the OIC, Department Head, or Supervisor, and fill in your phone number and email.
11. Finally, ensure the signature from the OIC, Department Head, or Supervisor is included before submitting the form.
12. Once you have completed all sections, make sure to save your changes, and download or print the form for your records or submission.

Start completing your documents online today to ensure timely access to essential systems.