To request access to the Nebraska Prescription Drug Monitoring Program


Have you viewed the training video?  

Please be aware that your request can not be approved until you complete the Training Video.  If you have not viewed it please stop now and use the link below.
 
Training Attestation
Training Attestation

Welcome to the NE PDMP User Access Request and Training Acknowledgement Form.

Before beginning the registration process please be prepared with the following:
  • Professional license number
  • Unique email address 
  • Copy of state professional license, wallet card, or diploma (for non-Nebraska license holders only)
 
If you have additional questions regarding this form or the registration process please refer to the PDMP User Access and Training Acknowledgement Form Instructions.
 
If you are having issues accessing your Nebraska PDMP account; do not submit a new request for access; instead please contact support at SUPPORT@CYNCHEALTH.ORG or 402-506-9900 option 1.

Is the person requesting PDMP access licensed in Nebraska?
Is the person requesting PDMP access licensed in Nebraska?
By checking the box below, the user attests that they have a treatment relationship with a Nebraska resident (Neb. Rev. Stat. § 71-2454) 2) and that the license is in good standing.
By checking the box below, the user attests that they have a treatment relationship with a Nebraska resident (Neb. Rev. Stat. § 71-2454) 2) and that the license is in good standing.
Please provide either Last 4 of Social Security Number or email address used on the state license (used for license validation with DHHS)
Please provide either Last 4 of Social Security Number or email address used on the state license (used for license validation with DHHS)
This information is used to validate State License
File attachments associated with the ticket.
Browse...

Other Fields

Your name
Verification Code