Add a New User Account

What is Your Name?

Your Organization

Your Phone Number

Your E-mail Address will be used to Contact you about your User Account.
An Example would be if you Forgot your Username or Password.

What is Your E-Mail Address?

Verify Your E-Mail Address

* E-Mail Addresses Are Not The Same

It is Recommended that your Username contain at least 8 characters.

Select a Username/Logon ID

It is Suggested that your Password contain at least 10 characters.
A Very Strong Password containing uppercase letters, lowercase letters, numbers, and special characters is recommended.

Select a Password

Verify Password

* Passwords Are Not The Same

Provide the Facilities and Providers that will appear in your dropdown lists. These are the organizations and individuals for which you will be entering flu cases. You may choose the order of the dropdown and when it will appear in and disappear from your dropdown. The National Plan and Provider Enumeration System can be searched for National Provider Identifiers here.

Facilities For Which You Will Enter Data

Add Facility

Facility

All

	Facility	Dropdown List Order	Begin Using Facility	Stop Using Facility

Providers For Which You Will Enter Data

Add Provider

Provider

All

	Provider	Dropdown List Order	Begin Using Provider	Stop Using Provider

When you Save your Account Information, you will be taken to the Sign-In Page where you will enter
your new Username and Password, Choose to Remember them, and Gain Access to the Website.

Save

Cancel