Field Name |
Description |
First Name (of user) |
Required. Free-text field with default value of logged in user's first name. Minimum length is 1; maximum length is 50. |
Last Name (of user) |
Required. Free-text field with default value of logged in user's last name. Minimum length is 1; maximum length is 50. |
Middle Initial (of user) |
Free-text field with no default value. Maximum length is 1. |
Select Existing |
A radio button selection and a list of Clinicians existing in WIR which are associated with the Provider Site. Choosing from the pull-down list will supply the Clinician Last Name and First Name but the user will be required to fill out the Title, Specialty, NPI/Medicaid number and Medical License number before adding to the Current Providers table at the bottom of the page. |
Create New |
A radio button selection will display the six required fields which all need to be filled by the user before adding a Clinician/Provider to the Current Providers table. |
Last Name |
Required. Free-text field with no default value. Minimum length is 1; maximum length is 35. |
First Name |
Required. Free-text field with no default value. Minimum length is 1; maximum length is 25. |
Middle Initial |
Free-text field with no default value. Maximum length is 1. |
Title |
Required. A drop-down list containing titles including but not limited to DO, MD, ND, NP, PA, Other. |
Specialty |
Required. A drop-down list containing specialties including but not limited to GP, Med, Peds. |
NPI/Medicaid Provider |
Required. Minimum length is 1; maximum length is 10. |
Medical License Number |
Required. Minimum length is 1; maximum length is 20. |
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Pressing Add Provider after filling all required fields will add the provider to the Current Provider table at the bottom of the page. NOTE: A drop-down list of clinicians within the practice is available when the organization has clinicians in the registry. |
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Pressing Cancel will stop the Provider from being added to the Current Provider table at the bottom of the page or stop changes being made to an existing Provider in the table. |
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Pressing Edit will display the provider information in the text fields for editing. |
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Pressing Save will record any updates to the provider selected from the provider table. |
Remove |
Pressing Remove will delete the selected provider from the Current Providers table. |
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Pressing Previous will return you to screen two of the enrollment process. |
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Pressing Continue will take you to screen four of the enrollment process. |
