TX HHS Form 5200. Med-IT New User Request

The TX HHS Form 5200, "Med-IT New User Request", is a crucial tool for Breast and Cervical Cancer Services (BCCS) Program Coordinators to request access to the Med-IT system. This form must be completed and dated by the coordinator, allowing three business days for Help Desk response.

This form consists of three sections: Agency Information, New User Information, and Signature. The required information includes Region No., Street Address, Building and Suite ZIP Code, Work Email Address, and Requested Role. The Requested Role determines the level of access granted to the new user, with options including CO Data Entry, Supervisor, or CO Patient Navigator.

The form should be submitted by email, and it is essential to note that the Help Desk response time is three business days. If no response is received after this timeframe, users can contact [email protected] for assistance. By completing and submitting Form 5200, BCCS Program Coordinators can efficiently request new user access to the Med-IT system.