Arizona Public Health Promoting Interoperability Portal Account Creation

Please complete one account for each group of hospitals (EH/CAH) or eligible clinician (EC) in your organization that meet the following criteria:

• attesting for the public health measures in the same reporting period
• using the same instance of the software(s) responsible for creating/sending the messages to public health

Hospital groups and eligible clinician (EC) groups must register separately, in other words, you cannot combine EH/CAH and ECs in the same account.

You can use the following PDF worksheets to gather the required information for registration with public health. Once your account has been created, you can save your work and return to complete the registration process.

• AZ Public Health Promoting Interoperability Registration of Intent EH and CAH
• AZ Public Health Promoting Interoperability Registration of Intent EC

After creating your account, please login to provide information regarding each measure selected.

Please complete the following:

• Account Profile
• List of Account Managers
• Sign In Credentials

Account Profile* are required fields

* Type of provider(s) ---Please Select--- Eligible Clinician(s) - EC Eligible Hospital(s) - EH Critical Access Hospital(s) - CAH EH(s) and CAH(s)

* What is the Account Name for the provider or group of providers for whom you are registering?

Parent Organization Affiliation

Account Managers* are required fields

Please provide contact information for persons responsible for administering your AZ Public Health Promoting Interoperability Portal account. At least one internal resource is required.

The contact person(s) added is/are responsible for:

• Maintaining AZ Public Health Promoting Interoperability Portal account
• Completing the Promoting Interoperability Registration of Intent with Public Health
• Receiving email correspondence from the ADHS Promoting Interoperability Coordinator

Add Account Manager

Contact Information* are required fields

Contact Type*

First Name*

Last Name*

Company*

Title*

Email*

Phone Number (Direct Line/Mobile)*

Fax Number

Sign In Credentials* all fields are required

Password must be at least 6 characters long and not exceed 20 characters and includes the following:

• One Uppercase letter
• One Lowercase letter
• One Special character
• One Numeric digit

Password

Confirm Password

Create Account