Computer Login Request and Agreement

BHD Information System

Computer Login Request and Agreement

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Please complete the form below to request or make changes to your computer login.

New User         Update          Password Reset             Deactivate

BHD Information System             

Functions Requested                      Please select a function below BHD Administrative Coordinator BHD Quality Assurance BHD Service Manager Mental Health CBRF Staff Mental Health CBRF Supervisor Mental Health Remote Access (TCM/CSP) WIser Choice Ancillary Provider WIser Choice Ancillary Provider Supervisor WIser Choice CIU WIser Choice CIU Supervisor WIser Choice Clinical Provider WIser Choice Clinical Provider Supervisor WIser Choice RSC WIser Choice RSC Supervisor Other       

Last Name:     First Name:    

Telephone #:   Example (xxx)xxx-xxxx     

Job Title:     

Email Address:

RU(s) / Provider ID(s):         Agency:    

Supervisor's Name:

Supervisor's Email Address:

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  For New Users Only

Thank you for initiating the creation of a BHD Information System Computer Login.

To complete the process, please print and sign the "Computer User Agreement Form"

and fax it to the Community Services Branch Management Services Section 

at (414) 257- 8198.

The Computer Login process will not be completed until the signed Computer User Agreement Form is received.

Computer User Agreement Form