Client Access Request Form - Optum Client Portal Site

Client Access Request Form for Optum Hospice Pharmacy Services

Name

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Title

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Email Address

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Phone Number

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Hospice Name

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Optum Group Number(s)

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Do you require access to the Optum Client Portal site (e.g. Hospi U, clinical library, webinars, etc)?

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Do you require access to HospiDirect? (Note: access requires approval of your manager)

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Do you require access to HospiTrac? (Note: access requires approval of your manager)

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If you require access to HospiDirect and/or HospiTrac, please provide your manager’s contact info below:

Provide any additional comments, if needed:

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NOTE: Optum will respond to your request via email.