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Point of Care Change Request

Use this form to request changes in access for your organization. Changes for individual users are made by your Point of Care Administrator.

Examples of changes:

  • Add or Remove Tax IDs
  • Add or remove Point of Care Administrators
  • Add create/update access for authorization features
  • Add or remove a designated agent

If you'd like to see the information that may be required, please Print a List of Information Required.

Before you begin, please ensure that you have your organization unit code and name and a legally authorized representative of the company to electronically sign this request.

To avoid delays in processing or the need to complete another form, please ensure that all information is entered accurately prior to submitting.

Complete ONLY the sections that are applicable for your desired changes. You'll be contacted with your access information within 3-5 business days.

If you have any questions about this request, please contact us at:





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