Form 15-25 "User Creation, Change, or Deletion - Careware Guidance Documents - Nevada Ryan White Part B" - Nevada

What Is Form 15-25?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 12, 2017;
  • The latest edition provided by the Nevada Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 15-25 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

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Download Form 15-25 "User Creation, Change, or Deletion - Careware Guidance Documents - Nevada Ryan White Part B" - Nevada

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Nevada Ryan White Part B
CAREWare Guidance Documents
User Creation, Change, or Deletion
 
 
INSTRUCTIONS: This form is to be completed digitally by the new user or user’s supervisor and forwarded 
to  the Office  of HIV/AIDS  via  CAREWareHelp@health.nv.gov.  Keep  a  copy  of  this  form  on  file  at  your 
agency. Please allow five business days to complete your request for account creations or modifications 
–  deletions  will  happen  upon  receipt.  For  questions  or  help  completing  this  form  please  contact 
CAREWareHelp@health.nv.gov. Handwritten forms will not be accepted. 
 
☐ New CAREWare User | ☐ Delete CAREWare User | ☐ Change CAREWare User Permissions 
 
Only Agency Name, Requestor Name, Supervisor Name, and Signature required for deletions. If specific 
permissions are needed, please describe in the Additional Comments/Notes section 
 
Date: 
 
 
Agency Name: 
 
First Name: 
 
Middle Initial: 
 
Last Name: 
 
Title: 
 
Work Street Address:  
 
City, State, Zip: 
 
   
   
Employee Work Phone (Including Ext.):  
 
Employee E‐Mail Address:   
Please select a provider type: 
☐ Clinical/Medical Provider 
☐ Eligibility & Enrollment Provider 
☐ Care Service Provider 
Supervisor Name: 
 
Supervisor Phone Number: 
 
Supervisor Signature: 
 
 
(Not required for Provider Administrator)
 
Additional Comments/Notes:  
 
 
 
Instructions: 
1.
This form is to be completed by the requestor, signed by the requestor’s supervisor (not 
required for a provider’s administrator), and e‐mailed to CAREWareHelp@health.nv.gov  
2.
Please supply any additional information deemed relevant in the comments section. 
3.
Once the completed form is received, a work order will be created. 
 
* Agencies are responsible to ensure deletion forms are turned in no more than one business day 
after an employee leaves the agency * 
15‐25: CAREWARE User Create/Change Form: Revised: 9/12/2017 
Nevada Ryan White Part B
CAREWare Guidance Documents
User Creation, Change, or Deletion
 
 
INSTRUCTIONS: This form is to be completed digitally by the new user or user’s supervisor and forwarded 
to  the Office  of HIV/AIDS  via  CAREWareHelp@health.nv.gov.  Keep  a  copy  of  this  form  on  file  at  your 
agency. Please allow five business days to complete your request for account creations or modifications 
–  deletions  will  happen  upon  receipt.  For  questions  or  help  completing  this  form  please  contact 
CAREWareHelp@health.nv.gov. Handwritten forms will not be accepted. 
 
☐ New CAREWare User | ☐ Delete CAREWare User | ☐ Change CAREWare User Permissions 
 
Only Agency Name, Requestor Name, Supervisor Name, and Signature required for deletions. If specific 
permissions are needed, please describe in the Additional Comments/Notes section 
 
Date: 
 
 
Agency Name: 
 
First Name: 
 
Middle Initial: 
 
Last Name: 
 
Title: 
 
Work Street Address:  
 
City, State, Zip: 
 
   
   
Employee Work Phone (Including Ext.):  
 
Employee E‐Mail Address:   
Please select a provider type: 
☐ Clinical/Medical Provider 
☐ Eligibility & Enrollment Provider 
☐ Care Service Provider 
Supervisor Name: 
 
Supervisor Phone Number: 
 
Supervisor Signature: 
 
 
(Not required for Provider Administrator)
 
Additional Comments/Notes:  
 
 
 
Instructions: 
1.
This form is to be completed by the requestor, signed by the requestor’s supervisor (not 
required for a provider’s administrator), and e‐mailed to CAREWareHelp@health.nv.gov  
2.
Please supply any additional information deemed relevant in the comments section. 
3.
Once the completed form is received, a work order will be created. 
 
* Agencies are responsible to ensure deletion forms are turned in no more than one business day 
after an employee leaves the agency * 
15‐25: CAREWARE User Create/Change Form: Revised: 9/12/2017