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Electronic Records Express
Create an Individual End-User Account

Dummy Link for Errors

An asterisk (*) indicates a mandatory field.

Demo Account

* User Id:

* First Name:

Middle Name:

* Last Name:

* Organization Type:

* Organization Name:

Department:

* Associated Sites:

Position:

* Office Phone:

Ext:

Cell Phone:

Ext:

Fax 1:

Ext:

Fax 2:

Ext:

* Primary Email:

Alternate Email:

* Address Line 1:

Address Line 2:

Address Line 3:

* Country:

* City:

* State/Territory:

* Zip Code:

Province :

* Postal Code:

* Primary Site:

* Primary Site Contact:

* Select the functions that apply to the user:

Consultative Examination Services:

Consultative Exam (CE)

Prepare CE Report for Provider (CEAP)

Review/Submit CE Reports (CEAS)

Consultative Exam with Scanned Signatures (CESS)

Evidence Submission Services:

Send Individual Case (MER)

Grouped Files (Grouped MER)

Communication Services:

Communications Utility (CU)

Secure Messaging (SM)

Document Exchange Services:

Send Transcription Report to Provider

Receive Transcription Reports

Payment Services:

CE Payment Request

MER Payment Request

Web Services:

ERE Web Services

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