DOH – MHF Web Form Demo

Choose one:


Step 1: Choose whether you are sending as the supervisor or the employee by clicking on the selection above.

Step 2: You will be redirected to the MMICS form. Be sure to answer all the fields as accurately as possible.

Step 3: Once all required fields have been completed, a blue “Click to Sign” button will appear.


Step 4: A pop-up window will appear allowing you to enter who your supervisor is, as well as any additional signers, if applicable. Medicaid users do not have to enter information for Participant 3. Only non-Medicaid users will need to enter the following: First name – Shandi, Last name – Wanlass, Email address –


Step 5: Another pop up window will appear prompting you to enter your email address. The email address entered here will receive a verification email. If you have not verified your email address, the form will not be submitted. Click on the “Click to sign” button when done.

Example 1
Example 2

Step 6: Click on the “Confirm my email address” link to initiate the process of submitting your form. The form will automatically route to the individuals you listed in step 4, and any additional signers required to complete this form. Once all signers have completed their portion of the signing process, all participants will receive a final copy of the form emailed to them.