Get Tcm System User Id Request - Department Of Health Care Services ...

Filling out the TCM System User ID Request form is an essential step for individuals seeking access to the Targeted Case Management system. This guide will provide you with comprehensive instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your request.

1. Click ‘Get Form’ button to acquire the user ID request form and open it for editing.
2. Begin by entering the LGA code and name in the designated field. This information is critical for identifying the local governmental agency associated with your request.
3. Fill in the name of the user making the request. Ensure that the name matches official records to avoid processing delays.
4. Provide a current email address. This will enable communication regarding the user ID request and any necessary follow-up information.
5. Enter a phone number, including the area code, in the space provided. This is important for any direct queries related to your application.
6. Select the user level from the appropriate options: LGA User, LGA Adm, DHCS User, DHCS Adm, or DHCS Accounting. Choose the level that best fits your role and responsibilities.
7. Complete the last four digits of your Social Security number in the specified field to verify your identity.
8. Indicate the start date of your access in the MM/DD/YYYY format. This date is essential for tracking your user account's validity.
9. If applicable, enter the end date of your access in the MM/DD/YYYY format. Leave this field blank if you are requesting indefinite access.
10. Read and understand the confidentiality agreement stated in the form. Acknowledge your responsibility to protect sensitive information about Medi-Cal services by signing the form.
11. Enter the date of signing in the designated area.
12. Provide your signature in the field indicated.
13. If you are an LGA Administrator and need to authorize, the authorizer signature section must also be filled out with the date.
14. For administrative use only, if required, the LGA or DHCS administrator will assign a user ID. This is typically done after the form has been processed.
15. Once you have completed all required sections, you can save your changes, download the form, print it, or share it as needed.

Complete your TCM System User ID Request form online today to ensure efficient processing.