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Western Highlands Network Care Coordination Information System (CCI) User ID Assignment Request Part I: This part must be completed by the applicant requesting the Western Highlands User ID for access
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To fill out Part I of this form, follow these steps:
01
Start by gathering all the necessary information for Part I. This may include personal details such as your name, address, phone number, and social security number.
02
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03
Read the instructions provided within Part I carefully. These instructions will guide you on how to fill out each section correctly.
04
Begin by entering your personal information in the designated fields. This may include your full legal name, current address, and contact information. Make sure to double-check the accuracy of this information to avoid any errors.
05
Next, provide any additional details that are required. This could include your social security number, date of birth, or any other information specific to the form.
06
After completing all the necessary fields, review your answers for accuracy and completeness.
07
If there are any sections or fields that are not applicable to you, mark them as "N/A" or leave them blank, depending on the instructions provided.
08
Finally, sign and date the form in the designated area, if required.
Anyone who is required to complete this form will need to fill out Part I. This may include individuals applying for certain licenses, permits, or registrations, as well as individuals providing information for legal or financial purposes. It is important to read the instructions carefully and provide accurate information to ensure the form is properly completed.
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