Thank you for signing up for the OneTouch EMR Silver Plan offered through Lake Health Alliance, Inc. In order to get you set up properly, please take a moment to complete the information needed below.

[uacf7-row][uacf7-col col:6] Do you already have a OneTouch account? —Please choose an option—YESNO [/uacf7-col][uacf7-col col:6] Your Account Name (if applicable):
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] Are you migrating to OneTouch from another EHR?
—Please choose an option—YESNO [/uacf7-col][uacf7-col col:6] If so, which EHR Vendor are you migrating from?
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:4] Your First Name: (Required)
[/uacf7-col][uacf7-col col:4] Your Last Name: (Required)
[/uacf7-col][uacf7-col col:4] Your Title: (Required)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] Your email: (Required)
[/uacf7-col][uacf7-col col:6] Your phone #: (Required)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] Name of Practice: (Required)
[/uacf7-col][uacf7-col col:6] Website Address (if applicable):
[/uacf7-col][/uacf7-row]

Practice Address: (Required)

[uacf7-row][uacf7-col col:4] City: (Required)
[/uacf7-col][uacf7-col col:4] State: (Required)
[/uacf7-col][uacf7-col col:4] Zip Code: (Required)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] Practice Specialty: (Required)
[/uacf7-col][uacf7-col col:6] How many providers are in your practice? (Required)
[/uacf7-col][/uacf7-row]

If you would like a Custom URL, please provide the name below. (i.e. abcmedical1234) If you leave the name blank, a name will be selected for you. NOTE: DO NOT SIGN UP FOR AN ADDITIONAL ACCOUNT. WE WILL SET THIS UP FOR YOU.

Desired Custom URL Name:

You must have at least 1 provider in order to purchase this plan.

[uacf7-row][uacf7-col col:4] Title of provider (select from drop down): (Required)
MDDODCDPMDDSPhDPANP [/uacf7-col][uacf7-col col:4] First Name of Provider (if different from above): (Required)
[/uacf7-col][uacf7-col col:4] Last Name of Provider (if different from above): (Required)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:4] NPI#: (Required)
[/uacf7-col][uacf7-col col:4] License#: (Required)
[/uacf7-col][uacf7-col col:4] State: (Required)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] DEA#: (Optional)
[/uacf7-col][uacf7-col col:6] NADEAN #: (Optional)
[/uacf7-col][/uacf7-row]

[uacf7-row][uacf7-col col:6] Provider's Cell Phone: (Required)
[/uacf7-col][uacf7-col col:6] Provider's email address: (Required)
[/uacf7-col][/uacf7-row]

The Provider's information will be submitted to OneTouch EMR. They will contact the provider directly to collect additional information.

If you would like to have your lab integrated into OneTouch EMR, please provide the following information.

[uacf7-row][uacf7-col col:4] Name Of Lab:
[/uacf7-col][uacf7-col col:4] Your Lab Account #:
[/uacf7-col][uacf7-col col:4] Approximate # of lab orders monthly:
[/uacf7-col][/uacf7-row]

If your lab request is with Quest Diagnostics, you may stop here. If it's with any other lab, please continue. NOTE: ALL OTHER LABS MUST CONTAIN THE INFORMATION LISTED BELOW OR INTEGRATION REQUEST CAN NOT BE SUBMITTED

[uacf7-row][uacf7-col col:4] Full Name of Lab Rep:
[/uacf7-col][uacf7-col col:4] Phone number of Lab Rep:
[/uacf7-col][uacf7-col col:4] Email address of Lab Rep:
[/uacf7-col][/uacf7-row]

Once received, we will submit to the lab/lab rep. Once approved by the lab, it may take 4-6 weeks for the new interface to be completed, and ready for use. We will contact you with any additional information needed.

If there are any additional details or information you'd like to share, please include them below. (optional)

I accept the Privacy Policy

Once you Submit this information, you will be directed to the order page.

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