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User ID
User ID
First Name
Last Name
Street Address
Signature
City
State
Zip
Location
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Cincinnati
Columbus
Dayton
Store
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Discipline
Select your Dicipline
RN
LPN
PT
PTA
OT
COTA
ST
MSW
Aide
Office
Employee Type
Select an Employee Type
Supervisor
Select your Supervisor
Jan Andrew
Christine Doggett
Vickie Flatter
Micki Fehring
Susan Hardin
Pam Mitchell
Jackie McCreary
Melanie Mobley
Missy Roush
Jennifer Lawson
Office
Practice Area
Unit Manager
Birth Date
i.e. (01/01/2009)
Account Manager?
Yes
No
Enabled?
Yes
No
Presenter?
Yes
No
Role
Public
Administrator
Admin
User
Manager
Groups
Group Choices
Primary Group
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Note:
If you do not have an email address your User ID will be created based on your name and birthdate.
Email
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