Get Onechart - User Access Request Form Purpose: This Form Applies To Non-credentialed Office Staff

Completing the OneChart - User Access Request Form is essential for non-credentialed office staff seeking access to the Methodist oneChart application. This guide will provide you with clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to successfully complete the form

1. Use the ‘Get Form’ button to access the form and open it for completion.
2. Enter your legal last name in the designated field. This information is essential for identifying your record.
3. Provide your legal first name as it appears on official documents.
4. If applicable, include your maiden name to assist in identifying your records.
5. Fill in your birth month and day to verify your identity.
6. Add your preferred name if different from your legal name.
7. Complete the company name with the name of the organization you represent.
8. Specify your middle initial (MI) in the provided field.
9. Enter the last four digits of your Social Security number for verification purposes.
10. If your provider group is different from your company name, list it in the appropriate section.
11. Include your phone number, fax number, and email address for communication purposes.
12. Select and answer one of the identification questions provided to ensure your security.
13. Sign your name in the user’s signature field to acknowledge that you have read and understand the Confidentiality Agreement.
14. Date your signature to complete this section.
15. For practice/site manager use only, select the user’s role from the dropdown list.
16. The practice/site manager will sign and date the form, confirming their authorization.
17. If applicable, the Health Choice Director/VP will also sign and date the form in the designated section.
18. Once all sections are completed, ensure the form is fully filled to avoid delays in processing.
19. Save any changes made to the form, and then download, print, or share it as necessary.

Complete the OneChart - User Access Request Form online today to gain the access you need.