DataViewer:Register

Register

STEP: 1 of 3

User Information

Please fill below user detail form before you continue to create new account
*Below information will be used by MDE administrator to validate user before granting permission to access to private reports and if any question below contact information will be used to reach user.

Offical Contact

Type of Access

Clicke here to view more information about access

Access Type Information
Access Type	-	Access Information with more details

MDH User	-	Maryland Department of Health will have access to Lead Acrediation data ( If you are Maryland Department of Health user and need access to Lead Abatement Data ? then please select this 'MDH User' as Access Type)
MDE Administrator	-	Only Maryland Department of the Environment can request this access ( If you are Employee of Maryland Department of the Environment? then please select this 'MDE Administrator' as Access Type)
Medicaid User	-	Medicaid users can access to Private data such as Lead Acrediation Risk assesors, Inspector, Contractor ( If you are Medicaid user and need access to Lead Abatement related Data? then please select 'Medicaid User' as Access type)

Job Title*

First Name*

Middle Name

Last Name*

Suffix

Email*

! *

Work Phone*

Ext

Cell Phone

Fax

Company/Business DETAIL

Company Name*	!
Street Address*	!
Unit/Suite
City*	!
State*	!
Zip*	! !
County*	!
Website (Url)