Complete the form below to initiate the process for signing up your program in the CONNECT System. Upon receipt of a completed form, your local regional administrator will make contact with your organization to set up next steps. Please allow up to five (5) business days for a reply.
Below is also a list of suggested steps to take in order to ensure your program is best prepared to use CONNECT.
1.) Become familiar with how the CONNECT Referral System functions.
This can be done by observing a live demonstration of the system, or the prerecorded version here. It is also recommended that new users engage in the CONNECT demo site to get a “feel” for using the system themselves. Head to our training resources page here to gain access to the CONNECT demo site.
2.) Review the CONNECT Memorandum of Understanding and client Release of Information PDF’s.
The MOU will require electronic signature by each individual user, as well as signature for each program operating in the CONNECT system. Ensure that whomever has signatory authority within your program reviews and consents to the MOU. The ROI is what is signed by each client in the CONNECT system.
3.) Become aware of which region(s) your program resides in by viewing the State of Montana Chronic Disease Bureau’s Regional Map.
4.) Prepare a list of external programs and providers where your program frequently sends and/or receives referrals from.
This information will be needed to complete the “referral mapping” section. Referral mapping allows us to make contact with your partner programs at a future date, to promote the use of the CONNECT system.
5.) Have all of your programs information ready when completing this form.
This includes but is not limited to: a description of services offered, details on your current referral process, insurance taken, and whom will be your programs Gatekeeper and Provider(s). Each field marked with a red asterisk is required.