Enrollments and Deactivations Please select the Enrollment/Deactivation Form from the drop-down. Select:Select from the drop-down menuAdd/Replace Workstation RequestAdministrator AuthorizationCloud Users Add/DisableDragon Medical One - DictationeFaxing (Updox)Electronic Case Reporting (eCR)Insurance Electronic BillingLab/InterfacesMIPS Assistance ProgramOrder SuppliesPatient BillingPatient Pay OnlinePatient PortalPatient Reminder ModulePayer InquiryProvider/Practice ServicesRegistries (Healthmonix, Immunization)Training Request Provider/Practice Services Activation - Register a provider for multiple services at once. Includes enrolling for E-Prescribing, Direct Messaging, EPCS , ePA Enrollment, PatientPortal and/or Waystar. Provider Deactivation Form Practice Level Direct Messaging Address – Request Form Prescription Drug Monitoring Program (PDMP) Enrollment Prescription Drug Monitoring Program (PDMP) Deactivation PatientPortal Enrollment and/or DeactivationCloud Clients – User Request Form STI Electronic Faxing Enrollment STI Electronic Faxing Deactivation Electronic Case Reporting (eCR) Enrollment Patient eStatements and Bill Reminders Enrollment Enroll a Practice for Waystar Enroll for Carisk No Fault and Worker's Compensation Claims Waystar Eligibility with Payer Inquiry Integration EnrollmentPatient Reminder Module EnrollmentPatient Pay Online EnrollmentChartMaker Mobile App Enrollment MIPS Assistance Program Enrollment (2024) MIPS Assistance Program Enrollment (2025) MIPS Attestation Assistance Quality Payment Program Healthmonix - STI Quality Reporting Registry Enrollment (2024) Healthmonix - STI Quality Reporting Registry Deactivation (2024) Healthmonix - STI Quality Reporting Registry Enrollment (2025) Healthmonix - STI Quality Reporting Registry Deactivation (2025) Immunization Registry Delaware DELVAX Immunization Registry 2.5.1 Enrollment KIDS Plus (Philadelphia) KIDS Enrollment Instructions KIDS Clinic-Enrollment Form New Jersey NJIIS Immunization Registry 2.5.1 NJIIS Consent to Share Form New York Checklist to Go Live with NYSIIS NY Immunization Registries 2014 Pennsylvania (Outside of Philadelphia) PASIIS Enrollment Instructions Provider Interest Form Final Confidentiality Policy Final Facility Agreement – HL7 PA-SIIS Implementation Form – HL7 Revised EMR-HL7 Profile Form Facility Matrix Virginia VIIS Immunization Registry 2.5.1 Lab/Interfaces Enrollment General Training Request Template Editing Request Primary Care First Assistance Request PCMH Assistance Request Administrator Authorization FormOrder Supplies FormAdd/Replace Billing Workstation Request FormDragon Medical One - Enrollment Form
