Get Confidentiality And Request Access Nrrs For Mds3 Form

This guide provides detailed instructions on how to effectively complete the Confidentiality And Request Access NRRS For MDS3 Form online. By following these steps, users can ensure that their submissions are accurate and comply with the necessary regulations.

Follow the steps to successfully complete the online form.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the contact information section, which includes the name of your organization, address, city, state, and zip code. Ensure that all details are accurate as this information will be used for communication purposes.
3. Provide the name and contact details of the person who will serve as the primary point of contact. Include their contact phone number and email address to facilitate any necessary communication.
4. Under the User Information section, list all individuals from your organization who have created an account to access the Nebraska Resource and Referral System for MDS 3.0 Section Q referrals. Include their names in the designated fields.
5. Select one individual from the list provided who will hold administrative access for your organization. This person will have full access to see all Section Q referrals and related reports.
6. Review the agreement regarding compliance with all ADRC and NRRS IT Security Policies, Procedures, and Standards. Acknowledge this agreement by checking the appropriate box.
7. Provide your signature and print your name below it to validate your agreement to the policies outlined in the form.
8. Include your title and the date of completion in the designated fields.
9. Once you have completed the form, save your changes, and you may also download or print it as required. Finally, fax the completed form to (402) 471-9092.

Complete your documents online today to ensure timely processing and adherence to regulations.