CT-WiZ onboarding HL7 Application

  •  The application process takes approximately 10-15 minutes to complete.
  •  If the organization has more than five locations, click on "More Than Five Locations" and complete the spreadsheet.
  •  Complete the required fields * on the form.
  •  At the bottom of the form, click on "Upload More Than Five Locations" and upload the "ClinicLocations" spreadsheet.
* - Required Field
National Provider Identifier
 Yes  No


 Yes  No

 Yes  No

 Yes  No
  •  If the organization has more than five locations, click on More Than Five Locations and completed the spreadsheet.

 Yes  No

 Yes  No

 Yes  No

 Yes  No


 Program Manager  Developer
 Yes  No
 Yes  No
 Yes  No
 Yes  No
How to attach file(s)

Click on "Select files....", select your document(s), click on "OPEN" and click "UPLOAD" to attach document(s) or "CLEAR" to remove document(s). You can only upload XLS, XLSX, XLSM files.