Get (chn) Invision/lcr User Id Request Form - Sfghed Ucsf

Filling out the (chn) Invision/lcr User Id Request Form is an essential step for individuals needing access to confidential health information systems. This guide provides clear instructions to help users navigate the form efficiently and correctly.

Follow the steps to accurately complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Provide your last name, first name, and middle initial in the respective fields to ensure proper identification.
3. For categories 1 or 2, complete the professional license number, DEA number, and UPIN where applicable, as this information is essential for verification.
4. Fill out your specialty and indicate whether you are a primary care provider by selecting 'Yes' or 'No'.
5. Enter your work location, work area, department or clinic, and title to help identify your professional role.
6. List your work phone number, pager number, and fax number to ensure communication is facilitated.
7. Provide your email address, ensuring it is valid for future correspondence.
8. Select your CHN affiliation by checking the appropriate box that reflects your association.
9. For users in category 1, indicate if you need a CHN number and Invision/LCR access, or if you already have a CHN number and only need Invision/LCR access. List the CHN number if applicable.
10. For category 2 applicants, specify if you need a provider number for billing purposes and if Invision/LCR access is required.
11. For users in category 3, circle whether you need a new Invision/LCR user ID or if you require changes or deletion of an existing ID. Provide additional details as necessary.
12. Have your immediate supervisor complete their section, including their printed name, title, work location, phone number, email, and signature to verify the necessity of access.
13. Finally, ensure you include a signed copy of the confidentiality statement and submit the form via fax or mail to the specified department.

Complete and submit your (chn) Invision/lcr User Id Request Form online today to gain the necessary access.