eDelivery Enrollment

STAT Informatic Solutions is a leader in innovative and cutting edge methodologies in delivery and management of protected health information. We are pleased to announce the release of our eDelivery Portal as a means to expedite payments and processes.

Company Name*
Email address of person completing this form*
Designated Portal Administrator for your Company
First Name*

Person at your company responsible for adding and revoking STAT Portal PHI Access
Last Name*
Job Title*
Designated Portal Administrator’s Company Email Address*

(username and password will be emailed)
Phone Number*
Mailing Address*
Please list the address currently used for hard copy delivery of PHI. Complete a new enrollment form for each additional address you wish to convert to eDelivery.

Street Address City State ZIP Code
Terms & Conditions*
Acknowledgement of Enrollment*
- I acknowledge that I am enrolling my company (the "Company") in STAT Informatic Solutions eDelivery Portal. I authorize STAT Informatic Solutions to provide the Company with copies of any/all requested records (including ePHI) electronically utilizing STAT Portal Services from this date forward.
Assigned Individuals*
- As part of the Company's enrollment form, I have assigned certain individuals to be the Company's administrators with respect to the STAT Portal Services (the "Administrators"). The Administrators will be responsible for granting access to designated employees of the Company, and for revoking access to the STAT Portal for employees that no longer have anything to do with the claim/case or are no longer employed by the Company and/or department. The Company, not STAT Informatic Solutions, shall be ultimately responsible for ensuring that only appropriate employees access the STAT Portal.

Designated Portal Administrator for your Company

Terms & Conditions*