OneHealthPort

iEXCHANGE® Pre-Registration Request

This form should be completed and submitted by a person in your organization who has an active OneHealthPort login and is an administrator in the OneHealthPort system. As an administartor in iEXCHANGE®, you will be asked to accept certain management responsibilities for your organization.

The System Administrator's responsibilities in iEXCHANGE® include:

Set up individual users in the system.
Verify the identity of individual physicians and users in your facility.
Notify Qualis Health when users leave/change status within the organization.
Set up the specific short diagnosis, procedure, physician and facility lists for your organization.
Confirm registration of other users.
Monitor iEXCHANGE® usage at your organization to ensure that users maintain proper security and confidentiality procedures and reset passwords when needed.

Serve as the primary point of contact at your organization for information regarding iEXCHANGE® By submiting this request you are accepting the duties as outlined in the document above.

Please complete this online form to Register your organization to access the Qualis Health iEXCHANGE® service.

All required fields are marked with an *
Your OneHealthPort Organization Id (OrgId) also called Affiliations is not something you may know off hand. You can look it up by using the "Test Your OHP Login" from the OneHealthPort Technical Support Page. Login to your account and select "Roles and Affiliations" and it will display one or more organizations you are affiliated with in your OneHealthPort account. The number listed under "Affiliations" is your OneHealthPort OrgId.

FIRST NAME*

LAST NAME*

Your OneHealthPort UserID*

ORGANIZATION NAME*

OneHealthPort OrgID

SPECIALTY*

YOUR ROLE in the Organization*

Job Title*

STREET 1*

STREET 2

CITY*

STATE*

ZIP CODE*

Phone(w/extension)*

FAX*

EMAIL ADDRESS*

I accept the role of Administrator*

Program participation*

What Happens Next:

Once you "submit" this form information, you will see a confirmation that your data has been submitted. Qualis Health will review and determine if your request is approved. If approved, the following will happen:

Use the link on the confirmation page to map your practitioner NPI numbers to your organization.
Qualis Health will send an email confirmation of your account setup.
Qualis Health will offer training options for iEXCHANGE® users.
You must complete training before starting use of iEXCHANGE®