(MIIX) USER AGREEMENT - Mississippi State Department of Health - msdh state ms 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Clinic/Facility or School Name at the top of the form. This identifies your organization.
3. Fill in the Contact Person(s) details, including their address, city, state, zip code, phone number, and email address. Ensure accuracy for effective communication.
4. List all employees requesting access by filling in their first name, last name, email address, position/title, and selecting an access level (Data Entry or Read Only).
5. Each user must sign next to their information to acknowledge understanding of the agreement terms.
6. Complete the signatures required from the Clinic/Facility Manager or authorized designee and MIIX representatives at the bottom of the form.
7. Once completed, save your document and return it as instructed. You can easily fax it using our platform for quick submission.

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