rediCASE & PMHCIS New User request form

Here are some tips for filling out the form to provide access for a new user or change a profile to rediCASE and PMHCIS.

DO NOT COMPLETE THIS FORM UNTIL your request has been approved by a delegated role within your organisation that authorises appropriate level of access to rediCASE and/or PMHCIS

Provide Accurate Information: Before submitting, double-check that all required fields are filled in. Make sure all details are correct and up to date to help avoid any delays.

If you require additional assistance in completing your form please do not hesitate to contact redicase@brisbanenorthphn.org.au

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Part A - Authorisation and delegation requests

Please ensure that your request has been approved by an authorised delegate role within your organisation before submitting the request'

Name of user requesting access

* required

Maximum 255 characters

0/255

Users contact email

* required

Address of your organisation

* required

Maximum 255 characters

0/255

Name of authorised delegate

* required

Maximum 255 characters

0/255

This can be your team leader, supervisor, manager or Executive but the authorised delegate must be aware of the system access request you require

Position of authorised delegate

* required

Maximum 255 characters

0/255

This can be your team leader, supervisor, manager or Executive but the authorised delegate must be aware of the system access request you require

Email of authorised delegate

* required

Maximum 255 characters

0/255

This can be your team leader, supervisor, manager or Executive but the authorised delegate must be aware of the system access request you require.