Sign Up Form

Select an option below:
Yes – sign me up now.
Yes, I elect to sign on with Brookdale Provider Link, but wish to speak with a representative from our local Brookdale Home Health or Hospice Agency before signing on board.
No – Not now – with reminder emails every 4 months

Provider Link – Administrative Set Up Registration Form:

Upon completing and submitting the registration form online, your profile will be updated. This means upon receipt, our Help Desk will update your profile to receive Orders, F2F Encounters and Vital Sign Alerts electronically via the physician portal versus faxes and or delivered by person.

There are two registration formats. Please choose one that best suits your Physician Practice needs.
Any questions, please contact our Help Desk at (888) 888-4489, option 4, option, 4, option 1, option 2
or email email the hithelpdesk@brookdale.com and include HCHB in the subject line.

 Format: 
Physician(s) Only
Physician Practice & Support Users

Are you a Solo Practitioner:
Yes   
No  
Agency Representative Filling Out Form:
Physician Name:
*
NPI Number:
*
Business Address: (street, city, state, zip)
*
Telephone Number:
*
Physician Email Address:
*
Group Practice Name if applicable:
*

Multiple Physicians:
If you selected No above and work with other physician(s) - such as a Group Practice – where a second or third physician can process your workflow, the following additional information is required:
Alternative Physician #1:
*
Name:
*
NPI #:
*
Email Address:
Alternative Physician #2:
*
Name:
*
NPI #:
*
Email Address:
Alternative Physician #3:
*
Name:
*
NPI #:
*
Email Address:
Alternative Physician #4:
*
Name:
*
NPI #:
*
Email Address:
Comments:

Physician Practice Support Users:
These individuals will not have the ability to “Electronically Sign” your orders or F2F Encounter forms, but Nurse Practitioners and Physician Assistants have the ability to “Review and Endorse” orders as well as F2F Encounters. Please refer to the “Role Matrix” for Role descriptions and their individual levels of access to Medical Records.
Support User #1
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #2
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #3
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #4
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #5
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #6
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #7
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #8
Office Role:
Name:
Practice Location:
Telephone:
Email Address:
Support User #9
Office Role:
Name:
Practice Location:
Telephone:
Email Address:

Registration Best Practices:

All individuals with Provider Link Access will initially receive 2 separate emails from HCHB Provider Link. The first email will include your username. The second email will include your temporary password. Upon receipt:

  • Save the Provider Link – website URL link to your Computer Desktop or Favorite
  • On your initial Log-In page, type your email address where prompted to receive email notifications of pending orders
*
Required Fields


To speak with a representative
Please complete the required fields and a Brookdale Representative
will contact you shortly.
Physician Name:
*
Practice Name if multi Physician:
 
Address: (street, city, state, zip)
*
Preferred means to contact your Practice?
Agency Representative Filling Out Form:
Role:
*
Telephone Number:
*
Email address:
*
*
Required Fields


Not now – with reminder emails every 4 months:
Please enter a valid email address.
Email address:
*

 

 

 

 



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