Get Calredie Reporter Account Authorization Form Version 7172017

Filling out the CalREDIE Reporter Account Authorization Form Version 7172017 is a crucial step for users to gain access to the Provider Portal for reporting communicable diseases. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
2. Complete Section 1 of the form, which is focused on Provider Portal User Registration Information. Provide your first name, last name, credentials, facility name, facility street address, city, state, facility zip code, direct work phone number, extension, and work email address. Ensure that you choose the correct email option regarding login information.
3. Read and agree to the user agreement stating your responsibility to protect your username and password. Sign and date the form in the designated area.
4. Once Section 1 is complete, prepare to send the entire form (all 3 pages) to your Local Health Liaison. They will complete page 2 and submit it, along with page 1, to the CalREDIE Help Desk.
5. Provide your Local Health Liaison with accurate Reporting Source(s) information if applicable. They will need to confirm that the sources are properly listed in the CalREDIE Report Source Dictionary.
6. Once all sections are completed and verified, save changes to the document, and use the options to download, print, or share the form as necessary.

Complete your CalREDIE Reporter Account Authorization Form online today to ensure timely access to the Provider Portal.