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Partner Registration Management (DFR)

Please choose from the dropdown the type of help you are requesting today.

Please provide specific details so that we may provide faster support.

You must answer the above question in order for the address fields to be visible

Select the number of tokens needed

Provide the number of tokens needed

DrFirst has a 90-day limited warranty period on hard tokens. This limited warranty excludes damage or loss.

Environment where error occurred - Production or Non Production

Please choose from the dropdown the type of issue you are having.

Date of Occurrence

Time that Occurrence Happened including Am/Pm. In the following format: 10:00 AM ; 1:30 pm.

What is the Logged in user's Full Name

What is the Logged in User Position Code / Role

What is the Facility's Location Name

What is the Facility NPI

What is the Patient's First Name

What is the Patient's Last Name

Please provide Patient's Date of Birth

What is the Patient's Zip Code

What is the Provider's Full Name

What is the Provider's NPI

Please provide the Medication Name

Please provide the Medication NDC (if known)

Please provide the Medication Sig Info (ex: 1 tablet daily)

Are there any Known recent change(s) updates to environment/EMR/application

Please enter the Provider's Full name for the Replacement Token

Please provide the Provider's NPI requesting the Replacement Token

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