Get Form E: Ereferral Client Or User Registration - Echn

Filling out the Form E: EReferral Client Or User Registration for the ECHN online is essential for healthcare practitioners and their authorized delegates to gain access to the eCHN Portal. This guide will provide you with step-by-step instructions to ensure your application is completed accurately and efficiently.

Follow the steps to fill out the Form E online.

1. Click the ‘Get Form’ button to obtain the form. This will open the document for you to begin filling it out online.
2. Part 1 requires you to fill in your personal information as a healthcare practitioner. Include your salutation, first name, last name, organization/office name, address, business telephone number, city and province, postal code, business email, job title, professional healthcare designation, college, and license number.
3. In Part 2, you must provide your signature and the date to confirm that the information you have submitted in Part 1 is accurate and that you agree to comply with the eCHN eReferral Terms and Conditions.
4. If you are an administrative staff applicant, proceed to Part 3. Fill in your salutation, first name, last name, organization/office name, address, city and province, postal code, business telephone number, business email, job title, and provide your signature and the date to confirm your compliance with eCHN eReferral Terms and Conditions.
5. Part 4 is for the healthcare practitioner authorizing the administrative staff. The practitioner must provide their name, date, signature, and college license number to confirm that the administrative staff is authorized to access the eCHN Portal on their behalf.
6. Review all information for accuracy before finalizing your application. Once completed, you can save your changes, download, print, or share the form as needed.

Complete your Form E application online today and streamline your access to the eCHN Portal.