Get Dc Calocus/locus User Account Or Termination Request 2009-2025

Filling out the DC CALOCUS/LOCUS User Account or Termination Request form is a straightforward process that allows users to either create or terminate their accounts. This guide provides clear, step-by-step instructions to ensure accurate completion of the form, tailored to meet your needs.

Follow the steps to successfully complete your request.

1. Click the ‘Get Form’ button to access the necessary document and open it in your preferred editor.
2. Enter the originator of the request's last name in the designated field labeled, 'Originator of Request'.
3. Input the first name of the originator in the following field. Optionally, include the middle initial.
4. Fill in the user’s last name in the 'User Information' section.
5. Provide the user’s first name and optionally include the middle initial.
6. Input the user’s office telephone number for contact purposes.
7. Specify the user's job title in the appropriate field.
8. Enter the user’s email address to facilitate communication.
9. Fill in the name of the organization or agency the user is affiliated with.
10. Provide the street address of the organization or agency.
11. Enter the city where the organization or agency is located.
12. Specify the state or district of the organization or agency.
13. Input the zip code for the organization or agency.
14. Check the box to request a login ID for access to the CALOCUS/LOCUS system.
15. If you wish to terminate an existing login ID, check the corresponding box.
16. Select the appropriate checkboxes to request access to LOCUS and/or CALOCUS as needed.
17. Indicate the user’s job title by checking the respective box.
18. The DMH Authority will complete the access level section; check boxes 24 to 29 as applicable. Ensure the user’s access is appropriately defined.
19. Check the box to certify your signature and agree to comply with HIPAA rules.
20. Obtain necessary signatures from the provider agency supervisor or designated authority, lead trainer, and DMH designated authority.
21. After completing the form, you may save changes, download, print, or share the form as needed.

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