Choose a type of site to create:
Site
Request access for a new site
Choose a type of user to create:
Provider
Request access for a provider (MD,DO,PA,NP, etc.) - access TCH clinical records and/or perform Texas Children's Health Plan activities
Clinical Staff
Request access for a clinical staff user (clinic nurse, clinic manager, etc.) - access TCH clinical records and/or perform Texas Children's Health Plan activities
Non-Clinician
Request access for a non-clinical user (front desk staff, claims) - view TCH patient demographics and appointments and/or perform Texas Children's Health Plan activities
Payor
Request access for a Payor role (utilization review or audit functions only) - DO NOT USE TO REQUEST TCHP ACCESS - For TCHP access, use other request forms based on user role