MDI Achieve
CareConnect User Maintenance Form (formerly MDI Connect)

Select the change you would like to request


User's first name:
User's last name:
User's e-mail address:
Add user to all facilities?
If no, please enter the facility names below.
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5.
2.
6.
3.
7.
4.
8.
Please indicate which product(s) this user is approved for.
On-Line Advantage
eCharting
RNet Therapy
QuickCare

User's first name:
User's last name:
CareConnect username:
Reset password?
Account locked?

Add facilities to this user

Remove facilities from this user
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1.
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3.
3.
4.
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5.
5.
Effective date:
User's first name:
User's last name:
CareConnect username:
Effective date:

Please complete your contact information

* Indicates a required field
First name: *
Last name: *
Facility name: *
Phone number: *
E-mail address: *
Parent company name:
Client ID: