Get Wits Access Form - In

Filling out the WITS Access Form - In is a crucial step for those involved in providing services through the Recovery Works program. This guide offers simple, step-by-step instructions to help users navigate the form efficiently and accurately.

Follow the steps to complete the WITS Access Form - In online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the name of your Recovery Works agency in the designated field. Ensure that the name is spelled correctly to avoid any processing delays.
3. Select the type of request you are making by choosing one of the options: Add Access, Change Access, or Remove Access. Make sure to read each option carefully to select the correct one.
4. Provide the full name of the provider or staff member needing WITS access, including both first and last names. Accurate input is essential for proper access management.
5. Enter the work telephone number with extension for the individual requiring access. This number should be current and reachable.
6. Input the unique email address of the provider or staff member. It should be an active email that can be used for communications related to WITS access.
7. Choose the appropriate level of WITS permission needed for the individual from the options available: Rendering Staff, Data Entry, Release to Billing, or Read Only. Select the option that best fits their role within your agency.
8. If there is an additional telephone number available, please provide it in the designated field. This can help with communication if necessary.
9. The form requires a signature from your agency's DARMHA designee. This signature confirms the request for access changes and should be provided in the specified area.
10. Date the form at the appropriate section to indicate when it was completed. This helps with tracking the request.
11. Finally, print the name of the DARMHA designee in the provided space to verify who authorized the request.
12. After reviewing all the information for accuracy, save the changes to your electronic version of the form. You can also download, print, or share the completed form as needed.

Ensure compliance and access by completing documents online today.