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Dear New User:
To register as a new NJIIS Site or Provider Group the following documents need to be completed:
  • Fax cover letter from medical provider's office.
  • Enrollment Request for New Sites and Provider Groups form (print here PDF   Word)

Please review the instructions before you fill out the Enrollment Request form.
Once the provider's site is registered with NJIIS, re-registration is not necessary to add new users.
New NJIIS authorized Users that will be working for the provider site and accessing the NJIIS database need to complete:
  • Fax cover letter from medical provider's office.
  • NJIIS User Enrollment and Training Request Form (print here PDF   Word).

 
The forms should be faxed to your local MCHC office, which can be found from our Training Opportunities Page.

For more information please contact the Help Desk at 1-800-883-0059 between 9am and 5pm,
Monday - Friday or email us at helpdesk@doh.state.nj.us

Upon review of the site Registration Form and our approval, your site will become an authorized NJIIS site.

We wish you success in using the NJIIS Registry.