TX HHS Form 5200. Med-IT New User Request

The TX HHS Form 5200, Med-IT New User Request, is a crucial document for the Breast and Cervical Cancer Services (BCCS) Program Coordinator. This form enables new users to request access to the Med-IT system, allowing them to document client and billing information, run reports, and access minimum data elements (MDE). The form must be completed and dated by the program coordinator.

The form requires agency information, including region number, street address, building and suite ZIP code, work email address, and requested role. The available roles include CO Data Entry, Supervisor, and CO Patient Navigator. The program coordinator is responsible for submitting the form by email and allowing three business days for Help Desk response. If no response is received after this time, users can contact [email protected].

Key features of the form include:

• New user request for access to the Med-IT system
• Required agency information and requested role
• Three business days for Help Desk response
• Contact information for follow-up actions