Get Vlo Uwhealth Org

Filling out the Vendor Liaison Office (VLO) registration form is a vital step for vendor representatives seeking to engage with UW Hospital and Clinics. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Vendor Liaison Office registration form.

1. Click the ‘Get Form’ button to access the registration form and open it in the online editor.
2. Enter the application date in the designated field, using the format MM/DD/YYYY.
3. In the 'Representative Information' section, fill in your name, title, and preferred mailing address, including city, state, and zip code. Provide your work phone number, mobile number, fax number, and pager number as applicable.
4. Continue by entering your email address in the corresponding field.
5. In the 'Representative’s Immediate Supervisor' section, fill out the supervisor's name, title, and mailing address, along with required contact numbers and email.
6. Next, provide the name of your company, headquarters address, city, state, zip code, and the company’s main phone number.
7. Input the company's web address in the appropriate section.
8. Indicate the products you represent by selecting 'Yes' or 'No' for vouchers for drugs.
9. If you are requesting patient contact, select 'Yes' or 'No' and briefly explain your request in the provided space.
10. Fill in the date you completed the Safety and Infection Control training and ensure to attach the verification printout.
11. Attach verification of a Criminal Background Check conducted within the last two years.
12. Provide documentation of your tuberculosis status, influenza vaccine, hepatitis B vaccinations, measure of immunity for measles, mumps, and rubella, and chickenpox status as required.
13. If you request scrubs, select 'Yes' or 'No' and provide an explanation for your scrubs request.
14. Once you have completed all sections, review the form for accuracy before finalizing.
15. You may save changes, download, print, or share the completed form as needed.

Complete the Vendor Liaison Office registration form online today to facilitate your engagement with UW Hospital and Clinics.