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If the device is a PC you must also complete the MIS System Access Request Form for Network Access. Winthrop University Hospital MIS System Access Request Form For Invision Access Instructions In order to get computer access at Winthrop please complete the checked areas only on both sheets and return to Academic Affairs. Name Signature Employee ID Number Mother s Maiden Name Today s Date mandatory Work Phone number Dr. /Dictation Number Social Security Number last 4 digits Location Shift Department Title/Job Description Deactivated by/Date Type of device do you have Terminal PC 2. 3. What functions on Invision do you need access to 4. Name of existing user in your department with Invision access that has the same job as you 5. Cash receipts Yes No Location The following information is required before your request can be processed Your Department Manager must fill out all information* Manager Authorization Lauren P. Petersen Title Phone Number Director of Academic Affairs 516-663-2521 MIS USE ONLY Login ID Revised June 15 2006 Sign On TCL Assigned By Date. Name Signature Employee ID Number Mother s Maiden Name Today s Date mandatory Work Phone number Dr. /Dictation Number Social Security Number last 4 digits Location Shift Department Title/Job Description Deactivated by/Date Type of device do you have Terminal PC 2. 3. What functions on Invision do you need access to 4. Name of existing user in your department with Invision access that has the same job as you 5. Cash receipts Yes No Location The following information is required before your request can be processed Your Department Manager must fill out all information* Manager Authorization Lauren P. Cash receipts Yes No Location The following information is required before your request can be processed Your Department Manager must fill out all information* Manager Authorization Lauren P. Petersen Title Phone Number Director of Academic Affairs 516-663-2521 MIS USE ONLY Login ID Revised June 15 2006 Sign On TCL Assigned By Date. 3. What functions on Invision do you need access to 4. Name of existing user in your department with Invision access that has the same job as you 5. Cash receipts Yes No Location The following information is required before your request can be processed Your Department Manager must fill out all information* Manager Authorization Lauren P. Petersen Title Phone Number Director of Academic Affairs 516-663-2521 MIS USE ONLY Login ID Revised June 15 2006 Sign On TCL Assigned By Date.

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