eReports Registration

Facility name (if applicable):

Facility or Provider NPI:

Name:

Username:

E-mail:

Phone:

eReports permissions level:

Level 1 (Non-financial reports, i.e. Quality Progress Reports)

Level 2 (Level 1 plus financial reports)

Authorization Attestation

I am authorized to request the level of information access for this user.

Name:

Title:

Registration Help

Toll free: 1-833-694-7761 Local: 650-616-2106

Fax: 650-616-8046

Monday 1:00 p.m. to 5:00 p.m. Tuesday–Friday 8:00 a.m. to 5:00 p.m.