- IEDRS Application

Affilitated Office and Credentials

Office Affiliation

Primary Role
Support Staff (Funeral Staff, Medical Staff, Coroner Staff)
Credential User (Funeral Director, Mortician, Medical Doctor, Physician Assistant, Nurse Practitioner)
Elected Official (Coroner, Deputy Coroner)

Basic Information

First Name

Middle Name

Last Name

Suffix

Phone

Phone Number cannot be longer than 10 numbers

Extension

Email Address

Non-Unique Email Address

CC Email Address

Preferred Communication Method

Cell Phone Carrier

Credential Information

Title

License Number

State of Licensure

License Expire Date

Credential Information

Title

County

Address Information

Address

Zip

Country

State

County

City

Final Information

UserName Take note of your user name: It will be required to log into EDRS

Your new Password must have

At least one lower case letter
At least one upper case letter
At least one special character. Allowed special characters are !*@#$%^&+=( )
At least one number
At least 8 characters length

Enter text shown

Password

Confirm Password

Pin Number

Confirm Pin Number

Security Questions

First Security Question

Answer

Second Security Question

Answer

Third Security Question

Answer

Account Registration

Your new Password must have

At least one lower case letter At least one upper case letter At least one special character. Allowed special characters are !*@#$%^&+=( ) At least one number At least 8 characters length

At least one lower case letter
At least one upper case letter
At least one special character. Allowed special characters are !*@#$%^&+=( )
At least one number
At least 8 characters length