Provider Link Registration - Superior

Provider Link Portal Registration Form

Sign orders and access patient records electronically.
Digitally access Plan of Care, Medication History, Patient Notes and Clinical/Discharge Summaires – improving coordination and communication with patient/family.

If you have any further questions, or need assistance setting up your account, feel free to contact us through:

Email: providerlinksupport@superiorforyou.com

Phone: (866) 825-8816

I AM A PHYSICIAN

For practicing physicians....

Start Here

I AM NOT A PHYSICIAN

For NP's, RN's, Physician Assistants, Resident, Office Staff...

Start Here

Physician Registration

First Name

Last Name

Street Address

Address Line 2

City

State

ZIP / Postal Code

Phone Number

Physician NPI Number (Optional)

License Number (Optional)

MD Medicaid Registered

MD Pecos

Hospital (Optional)

Department (Optional)

Service (Optional)

Tax Payer Identification Number (TIN) (optional)

Additional Practice Location

If none, leave blank.

Clinical / Pracitce Name (Optional)

Street Address (Optional)

Address Line 2 (Optional)

City (Optional)

State (Optional)

ZIP / Postal Code (Optional)

Phone Number (Optional)

Delegate Access is determined by role type: Nurses, Physician Assistants, and Unlicensed Residents will have co-sign access allowing them to review and pre-approve your clinical orders. Unlicensed office support staff will have read-only access to view, but not approve or change your clinical orders.

First Name (Optional)

Last Name (Optional)

Email (Optional)

Role (Optional)

Delegate NPI Number (optional)

License Number (optional)

Agreement Text

In consideration for utilizing Superior Home Health I certify that I am a Physician licensed to practice medicine in the State of Texas, and I agree as follows: This Physician Portal Agreement is for the purpose of allowing physicians to review the electronic records of their patients who are receiving the services of Superior Home Health and its affiliates, to authenticate their medical orders via the portal, and to facilitate physician-agency communication regarding patient service. The Portal System user will use and disclose protected health information in accordance with the requirements for covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Portal System user will hold all information in strictest confidence in the processing and storage of all data. Only authorized personnel will have access to electronic data accessible via the portal or to any data printed from the portal. Patient information will be accessible only as appropriate to a particular physician’s portal and its authorized users. Each authorized portal user will be assigned an individual password or access code by Superior and will complete a signed statement that no one else will be allowed to use his or her computer key. Signed staff security statements and pass code identification files will be secured and maintained in the physician’s office. Information via remote terminals will be filtered through these passwords and security checks creating an audit trail to identify individual users when necessary. Only an authorized practitioner may authenticate home health care patients’ orders per CMS regulation. Under no circumstances will the physician’s office staff member authenticate or authorize medical orders on behalf of the physician using the physician’s password. As a user of this portal system, and signatory to this agreement, I hereby agree to these terms of usage.

Non-Physician Registration

First Name

Last Name

Street Address

Address Line 2

City

State

ZIP / Postal Code

Phone Number

My Role

My NPI Number (Optional)

License Number (Optional)

Associated Physician

Associated Physician 2 (Optional)

Associated Physician 3 (Optional)

Associated Physician 4 (Optional)

Associated Physician 5 (Optional)

Associated Physician 6 (Optional)

I agree

Provider Link Portal Registration Form

Sign orders and access patient records electronically.
Digitally access Plan of Care, Medication History, Patient Notes and Clinical/Discharge Summaires – improving coordination and communication with patient/family.

If you have any further questions, or need assistance setting up your account, feel free to contact us through:

Email:

providerlinksupport@superiorforyou.com

Phone:

(866) 825-8816

I AM A PHYSICIAN

For practicing physicians....

Start Here

I AM NOT A PHYSICIAN

For NP's, RN's, Physician Assistants, Resident, Office Staff...

Start Here

Physician Registration

First Name

Last Name

Street Address

Address Line 2

City

State

ZIP / Postal Code

Phone Number

Physician NPI Number (Optional)

License Number (Optional)

MD Medicaid Registered

MD Pecos

Hospital (Optional)

Department (Optional)

Service (Optional)

Tax Payer Identification Number (TIN) (optional)

Additional Practice Location

If none, leave blank.

Clinical / Pracitce Name (Optional)

Street Address (Optional)

Address Line 2 (Optional)

City (Optional)

State (Optional)

ZIP / Postal Code (Optional)

Phone Number (Optional)

First Name (Optional)

Last Name (Optional)

Email (Optional)

Role (Optional)

Delegate NPI Number (optional)

License Number (optional)

Agreement Text

Non-Physician Registration

First Name

Last Name

Street Address

Address Line 2

City

State

ZIP / Postal Code

Phone Number

My Role

My NPI Number (Optional)

License Number (Optional)

Associated Physician

Associated Physician 2 (Optional)

Associated Physician 3 (Optional)

Associated Physician 4 (Optional)

Associated Physician 5 (Optional)

Associated Physician 6 (Optional)

I agree