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HMIS / Service Point Training Request

  1. Enter First and Last Name (person submitting the training request)

  2. Enter the provider page ID numbers for the programs that the new user needs access to separated by a semicolon. For example, 7082; 9062; 1234

  3. Has the user passed the initial MCAH Privacy and Confidentiality questionnaire?*

  4. Leave This Blank:

  5. This field is not part of the form submission.