Forms 2018-01-26T20:09:49+00:00

Forms

To join Reliance, please complete and submit the following Reliance Enrollment Form:

Reliance Enrollment Form

Once your clinic or practice is enrolled, you can complete and submit the Reliance Provider Change Form to add or remove health care providers from your practice.

Reliance Provider Change Form

Reliance will soon be providing seamless access to Oregon’s Prescription Drug Monitoring Program (PDMP). As a Reliance user, you will be able to retrieve PDMP information through your Reliance Community Health Record (CHR) log in.  To participate, please complete the Reliance PDMP Service Agreement and one of our Implementation Specialists will be in touch to schedule training.

Reliance PDMP Gateway Subscription Agreement

Please Email all completed forms to info@RelianceHIE.org. You can also call 1-855-290-5443 or fax 541-833-0504 for more information.

Keep Up to Date

Stay current with news & information from Reliance.