CIX Clinic / Provider Application Form

CIX Clinic / Provider Activation Form

CIX delivers lab and imaging results from Northern Health labs and Imaging departments

CIX has been delivering lab results since February 2010 and Imaging since November 2010.

Please complete the form below.

Only Northern Health facilities will support electronic delivery through the CIX service.

I'm new to CIX	I already use CIX
Requested date of activation:
You will be contacted at the information provided below to confirm your activation date. Please ensure you have made arrangements with your vendor to have CIX configured for this date so that results are not being entered both manually and electronically.
EMR Vendor Information
Name:
Contact:
Contact Email:
Clinic Information
Name:
Address:
Contact:
Phone:
Fax:
Email:
List all physicians and corresponding MSP billing numbers to be included in the CIX service:
Comments:
I accept that results that are electronically delivered by Northern Health will no longer be delivered by fax.
I agree to gain office access to the Cerner Millennium system for when the CIX service is unavailable.

ITS Service Desk:	1-888-558-4357 or 250-565-2784 or itsservicedesk@northernhealth.ca
CIX Info:	cix@northernhealth.ca