Common Contracts
1 similar Individual User Agreement contracts
Individual User AgreementIndividual User Agreement • August 16th, 2004
Please complete the following information for anyone in your practice who will need access to CHIRP Web. Each individual must sign this form prior to receiving a User ID and password. Complete and return this form with the Provider Enrollment Agreement. When an authorized user leaves this site, the site manager or designee must fax the Remove User form to the CHIRP program office within one week of the employee's last day of employment.
