ILPMP Registration

Test

Test

Extension

SecurityQ2Test

Security Question 3

Terms and Use Agreement

Terms and Use Agreement

Terms of Use must be agreed to in order to open a PMP account.

An error occured, please check your submission.

Illinois State License Number

Enter Valid License Number

That License Number has already been registered!

TestFName

TestLastName

TESTEMAIL

testConfirmEmail

Test

TestPassword

testConfirmPassword

Test

Phone Number

Extension

Enter Last 4 Digits of SSN

Enter Valid Practice Name Number

Business Address

Enter Valid Address

City

Enter Valid City

State

Enter Valid State

Zip Code

Enter Valid Zip Code

Enter Valid NPI Number

DEA Number

Enter Valid DEA Number

That DEA Number has already been registered!

Security Question 1

SecurityQ2Test

Security Question 3

Terms and Use Agreement

We will use the information to verify your identity and the authenticity of your access request. License status will be verified by using the applicable state's professional license lookup services. For verification purposes, all information is required and submitted information will remain confidential.

The use of the Prescription Inquiry Library (PMP) is intended for and may be only used for medical purposes.

I give the Prescription Monitoring Program and its representatives permission to contact me through the contact information I provided.

I understand that Illinois Law (720 ILCS 570/318) and US PL 104-191 prohibit the disclosure or discussion of any personal health information without proper written authorization.

I understand that I am personally responsible for all usage associated with this user ID.

I further understand that system usage is logged, and my access to the system may be denied or revoked at the discretion of the IDHS Bureau of Pharmacy and Clinical Support Services' Prescription Monitoring Unit.

Terms of Use must be agreed to in order to open a PMP account.

An error occured, please check your submission.

Illinois State License Number

Enter Valid License Number

That License Number has already been registered!

TestFName

TestLastName

TESTEMAIL

testConfirmEmail

Test

TestPassword

testConfirmPassword

Test

Phone Number

Extension

Enter Last 4 Digits of SSN

Enter Valid NPI Number

Practice Type

Enter Valid Practice Type

Enter Valid Practice Name

Business Address

Enter Valid Address

City

Enter Valid City

State

Enter Valid State

Zip Code

Enter Valid Zip Code

Security Question 1

SecurityQ2Test

Security Question 3

Terms and Use Agreement

We will use the information to verify your identity and the authenticity of your access request. License status will be verified by using the applicable state's professional license lookup services. For verification purposes, all information is required and submitted information will remain confidential.

The use of the Prescription Inquiry Library (PMP) is intended for and may be only used for medical purposes.

I give the Prescription Monitoring Program and its representatives permission to contact me through the contact information I provided.

I understand that Illinois Law (720 ILCS 570/318) and US PL 104-191 prohibit the disclosure or discussion of any personal health information without proper written authorization.

I understand that I am personally responsible for all usage associated with this user ID.

I further understand that system usage is logged, and my access to the system may be denied or revoked at the discretion of the IDHS Bureau of Pharmacy and Clinical Support Services' Prescription Monitoring Unit.

Terms of Use must be agreed to in order to open a PMP account.

An error occured, please check your submission.

Badge Number

Enter Valid License Number

TestFName

TestLastName

TESTEMAIL

testConfirmEmail

Test

TestPassword

testConfirmPassword

Test

Phone Number

Extension

Enter Last 4 Digits of SSN

Agency Name

Enter Valid Agency Name

Agency Address

Enter Valid Address

City

Enter Valid City

State

Enter Valid State

Zip Code

Enter Valid Zip Code

Security Question 1

SecurityQ2Test

Security Question 3

Terms and Use Agreement

We will use the information to verify your identity and the authenticity of your access request. License status will be verified by using the applicable state's professional license lookup services. For verification purposes, all information is required and submitted information will remain confidential.

The use of the Prescription Inquiry Library (PMP) is intended for and may be only used for medical purposes.

I give the Prescription Monitoring Program and its representatives permission to contact me through the contact information I provided.

I understand that Illinois Law (720 ILCS 570/318) and US PL 104-191 prohibit the disclosure or discussion of any personal health information without proper written authorization.

I understand that I am personally responsible for all usage associated with this user ID.

I further understand that system usage is logged, and my access to the system may be denied or revoked at the discretion of the IDHS Bureau of Pharmacy and Clinical Support Services' Prescription Monitoring Unit.

Terms of Use must be agreed to in order to open a PMP account.

An error occured, please check your submission.

Your Registration has been received!

You will receive an email at the address that was entered with details pertaining to your registration. Your registration may need to be reviewed based on the information entered. You will be contacted within 2 to 3 business days.

Thank you for registering with the Illinois Prescription Monitoring Program!

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