Enrollment Forms

In order to utilize UHIN's services, click on the on the link below to open up the appropriate ECA. Review and sign the document. Then mail the form to UHIN. You may want to print the frequently asked questions document as well. Some of the legal terms can be confusing. Should you have any questions please contact UHIN.

UHIN Electronic Commerce Agreement

UHIN Attachment A for Providers/Billing Services

UHIN Attachment A for Hospitals

UHIN Attachment A for Payers

UHIN Attachment A for Clearinghouses

UHIN Attachment A for Wal-Mart

UHIN Attachment for UHIN Transactor (UHINt)

UHIN Non-Disclosure Agreement

Frequently Asked Questions

Note: You must have Adobe Acrobat Reader in order to view or print the ECA. Click here to get the software.