New User Request Form

If you are in an office that is currently using MHC’s HIE Command Center and tools and need to add a new user, please fill out the access agreement below.

We are now able to accept electronically signed Access Agreements using the form linked below and may be submitted electronically (there is a submit button on the form), faxed to 616-588-4710 or mailed to Michigan Health Connect, 4829 East Beltline NE Suite 303, Grand Rapids, MI 49525.

Access Agreement

For instructions on how to create an electronic signature in Adobe, please see the following Guide:  Creating an Electronic Signature

This Access Agreement must be completed by each individual requesting a user ID and password on the Michigan Health Connect health information exchange.

Deleting a User

When you need to have a user account deactivated because an individual is no longer working in your office, please immediately email support@michiganhealthconnect.org with the office name and user name to be deactivated.

New Office?

If your office is not currently using the MHC HIE Command Center and tools but you’d like more information on how you can join the state-wide network, please e-mail info@michiganhealthconnect.org to schedule a time to talk with a member of our team.