Designated EHR Contact Intake Form

The BBS EHR Registry

Use this form to provide us with new or revised EHR contact information at any time. There is no deadline and no limit on how often you can update it.

Your Designated EHR Contact is the person who should receive Faith’s Law employment history requests about your former employees.

Start typing to find your organization. Please give the full formal name exactly as you want it presented in the Registry.
First and last name of your specific EHR contact person.
The email address that should receive Faith’s Law requests.
Street address for your organization.

One suggestion worth the five minutes it takes

Rather than listing an individual, ask your IT staff to create an EHR specific email address, such as FaithsLaw@yourorganization.org, and point it at whoever currently handles these requests. When that person changes roles or leaves the organization, you simply redirect the mailbox. Without it, your organization risks becoming unreachable or losing control over who answers EHR requests on its behalf.

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Thank you — we have it.

Your organization’s Designated EHR Contact has been recorded in the BBS EHR Registry. You can return to this form and update it at any time.