Services Website Enrollment

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Phillip Gilmore
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1 Secure HELP A NEW Start PATIENT ENROLL Services Website Enrollment Use this step-by-step guide to create your Secure Start services online profile, facilitate a new online continence care patient enrollment, and more. p.1 Please call your dedicated Secure Start services coordinator at with questions.

2 CONTENTS MY PROFILE MY PROFILE Step 3: Verify patient enrollment information p.2 Please call your dedicated Secure Start services coordinator at with questions.

3 My profile 1 To begin, go to and click the Secure Start Services tab. Click Need to Register? at the top of the page to create a new profile. 2 Fill in your contact information. 3 Create a password. Your password MUST include 8 or more characters with 3 of the following: Uppercase letters Numbers Lowercase letters Symbols Your password CANNOT contain three repeating letters or numbers (e.g., aaa or 111), or the words Hollister or password. p.3 Please call your dedicated Secure Start services coordinator at with questions.

4 4 Fill in the information for your primary facility, as well as any additional facilities where you work. You must include at least one facility. 5 Complete the security validation (recaptcha) if necessary. 6 Read the acknowledgment and check the box to acknowledge terms and conditions. Click Submit. 7 Click My Pages to help a new patient enroll, access your Patient List, or update your profile. p.4 Please call your dedicated Secure Start services coordinator at with questions.

1 Go to www.hollister.com and click the Secure Start Services tab. Enter your login information and click Login.

3 Enter all required patient information.

5 1 Go to and click the Secure Start Services tab. Enter your login information and click Login. (If you need to create your profile, refer to page 3.) 2 Scroll down to Help a New Patient Enroll and click the Continence Patient button. 3 Enter all required patient information. Although your patient s address is optional, we strongly encourage you to obtain one as it is an important way for the Secure Start services team to stay in touch with your patient. p.5 Please call your dedicated Secure Start services coordinator at with questions.

6 4 Indicate your patient s current condition. 5 Select your facility name from the dropdown menu. If you have recently created your clinician profile, the facility name may still read Pending Profile Update. Our team will update your patient s profile accordingly. 6 Under the Optional Offerings at Enrollment section, indicate: If your patient wants an introductory kit (you will customize the contents on the following page) If your patient wants help selecting product supplier options (if yes, you have the option to provide your patient s insurance information) Click Continue. If your patient does not want an introductory kit, select no and you can skip to step 3 of the enrollment process (page 9). p.6 Please call your dedicated Secure Start services coordinator at with questions.

7 1 To customize your patient s introductory kit, search for samples and literature by stock number or refine your search by selecting from the options on the left-hand side. The standard introductory kit includes condition-specific education, lifestyle literature, guides for use, and a backpack or waist pack. 2 Add samples and literature to your cart by clicking the shopping cart icon. Please limit to 20 items per introductory kit, as patient feedback has indicated too many items can be overwhelming. 3 Select whether your patient would like a backpack or a waist pack. p.7 Please call your dedicated Secure Start services coordinator at with questions.

8 4 Add any additional comments that will assist in processing your patient s introductory kit. Click Continue at the bottom of the page. p.8 Please call your dedicated Secure Start services coordinator at with questions.

9 Step 3: Verify patient enrollment information 1 Confirm your patient s information and introductory kit details. If the information is not correct, click the red X next to the item to remove it from your cart or Go Back to modify the introductory kit request. 2 Your patient s prescription is required for us to send continence care samples. Click Browse to upload your patient s prescription. You can also fax it to To obtain written patient consent, we offer two options: Enter your patient s address in the space provided. Your patient will receive an with instructions to confirm consent. Use the Patient Care Plan, which will be visible on the following page.! Please note patient enrollment will not be processed without receipt of written patient consent. p.9 Please call your dedicated Secure Start services coordinator at with questions.

4 Read the acknowledgment and check the boxes to: Acknowledge verbal consent for patient enrollment (required) Receive email confirmation for request (optional) Click Confirm Request.

10 4 Read the acknowledgment and check the boxes to: Acknowledge verbal consent for patient enrollment (required) Receive confirmation for request (optional) Click Confirm Request. Please note that it may take up to two business days for the patient s enrollment and introductory kit order to appear in your Patient List. 5 The Patient Care Plan can be printed out and provided to the patient as a confirmation of their enrollment in Secure Start services. It also can be used to obtain the patient s written consent. After Step 3 of the enrollment process, click View Patient Care Plan and follow these steps: a) Download printer-friendly version to print or save as a PDF b) Obtain written patient consent with signature c) Fax form to or form to securestartservices@hollister.com! You will not be able to access the Patient Care Plan after you leave this screen. p.10 Please call your dedicated Secure Start services coordinator at with questions.

11 6 Click My Pages to help a new patient enroll, access your Patient List, or update your profile. p.11 Please call your dedicated Secure Start services coordinator at with questions.

1 To begin, go to www.hollister.com and click the Secure Start Services tab. Scroll down to Help an Existing Enrollee and click View Patient List.

12 1 To begin, go to and click the Secure Start Services tab. Scroll down to Help an Existing Enrollee and click View Patient List. Your Patient List will include patients you have helped to enroll, regardless of the enrollment method. 2 In your Patient List, select a name to view the patient s profile. 3 Click Request Sample for this Patient. Sample order history and tracking information are available at the bottom of each patient s profile page. p.12 Please call your dedicated Secure Start services coordinator at with questions.

13 4 Verify that your patient s information is correct, or use the text box to share updated patient information with the Secure Start services team. Click Continue. 5 Search for samples and literature by stock number, or refine your search by selecting from the options on the left-hand side. 6 Add samples and literature to your cart by clicking the shopping cart icon. 7 At the bottom of the page, add any additional comments that will assist in processing your patient s order. Click Continue. p.13 Please call your dedicated Secure Start services coordinator at with questions.

8 Confirm your patient s information and order details. If the information is not correct, click the red X next to an item to remove it from your cart or Go Back to modify the order request.

14 8 Confirm your patient s information and order details. If the information is not correct, click the red X next to an item to remove it from your cart or Go Back to modify the order request. 9 Your patient s prescription is required for us to send continence care samples. Click Browse to upload your patient s prescription. You can also fax it to Click Confirm Request. You do not need to include a new prescription if there is a valid prescription on file for your patient. Please note that it may take up to two business days for the patient s order to appear in your Patient List. 10 Click My Pages to help a new patient enroll, access your Patient List, or update your profile. p.14 Please call your dedicated Secure Start services coordinator at with questions.

1 To begin, go to www.hollister.com, enter your login information, and click Login. Scroll down to Help an Existing Enrollee and click View Patient List.

15 1 To begin, go to enter your login information, and click Login. Scroll down to Help an Existing Enrollee and click View Patient List. Your Patient List will include patients you have helped to enroll, regardless of the enrollment method. 2 In the Patient List, click a name to view the patient s profile, including Patient Notes. Patient Notes facilitate two-way communication between the Secure Start services team and nurses for the benefit of the patient. 3 To send an update on your patient, scroll down to enter text in the box provided and click Submit Note. A member of the Secure Start services team will follow up with you or your patient as needed within two business days. p.15 Please call your dedicated Secure Start services coordinator at with questions.

16 4 Click My Pages to help a new patient enroll, access your Patient List, or update your profile. p.16 Please call your dedicated Secure Start services coordinator at with questions.

17 Who is my dedicated Secure Start services coordinator? Log in to your profile to see your coordinator s name and contact information, or enter your zip code under Contact Us on the Secure Start services home page. What if I have two patients with the same name? Use the enrollment date to distinguish between two patients with the same name in your Patient List. What happens if I don t print the Patient Care Plan? If you do not print or save the Patient Care Plan at the time of enrollment, you will not be able to go back and access it later. Contact your dedicated Secure Start services coordinator if you have questions. Is a patient s required for enrollment? Although your patient s address is optional, we strongly encourage you to obtain one as it is an important way for the Secure Start services team to stay in touch with your patient. What happens if I move to a new facility? Contact your dedicated Secure Start services coordinator or call us at Is my profile immediately active in the system after submitting my information? Your profile information will be visible, but your facility information will be blank. It may take up to two business days for your facility information to appear in your profile. If I start a patient enrollment but don t finish it, is partial information stored? Yes, partial patient enrollment information is stored. You can update your partial enrollments at any time by accessing your Patient List. Why can t I see all of my patients in the Patient List? You only see 15 patients in your Patient List at a time. Click Next to view additional pages of patients. If you do not see a patient you are looking for, please contact your dedicated Secure Start services coordinator or call us at Who do I contact for tech support? Contact your dedicated Secure Start services coordinator or call us at p.17 Please call your dedicated Secure Start services coordinator at with questions.

18 Hollister Incorporated 2000 Hollister Drive Libertyville, Illinois Secure Start services are free of charge, and there is no obligation to purchase anything to receive them. Product samples are provided for the patient s trial use and cannot be resold or billed. There is no obligation to accept samples or participate in insurance matching to identify supplier options. Hollister Incorporated reserves the right to change Secure Start services at any time. The Hollister logo, Adapt, Secure Start, and Secure Start It s Personal are trademarks of Hollister Incorporated Hollister Incorporated p.19 Please call your dedicated Secure Start services coordinator at with questions.

Services Website Enrollment

Secure HELP A NEW Start PATIENT ENROLL Services Website Enrollment Use this step-by-step guide to create your Secure Start services online profile, facilitate a new online ostomy patient enrollment, and