WebIZ Enrollment FORMS

FACILITY ENROLLMENT:

If your facility has never enrolled in WebIZ, you will need to complete a FACILITY enrollment form. A facility enrollment must be on file before any USER accounts are created. Facilities must be enrolled to associate USER accounts to them, but you will not get log in credentials for a facility account. 

USER ENROLLMENTS: There are 2 types of user enrollment forms.

1. The "New USER enrollment form" is for new hires that will need to log into the registry to chart vaccines, update demographics, handle inventory issues, and print records for patients. This form MUST be completed, signed, and sent into the Helpdesk by the individual requesting access. Enrollments submitted by anyone else will be turned away.

2. The "Non-Interactive User enrollment form" is for Doctors, APN's, & Nurses that will need to show up in the drop down boxes for charting, but will never log onto WebIZ themselves. This form can be filled out by anyone in the facility as long as the user being added is aware. We do not send personal log in credentials to these accounts so we can accept these enrollments by entities other than the enrollee. Users that are enrolled under this form will NOT be able to log into the registry for any reason. 

In order to successfully submit your completed enrollment form, you will need to select the appropriate form below, complete the PDF form on your computer, and save the completed copy to your PC. Then you will need to submit a ticket for the enrollment and add your saved/completed copy to the ticket. Please make sure to select the appropriate ticket category when submitting enrollments.