Get Ehipaa Computer Access Request Form.doc

The EHIPAA Computer Access Request Form is a crucial document for employees requiring access to computer systems and software within Premier Health Care Management. This guide provides detailed, step-by-step instructions to help users fill out the form efficiently and accurately online.

Follow the steps to complete the form successfully.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the date at the top of the form, ensuring it reflects the current date.
3. In the Employee Information section, fill in your first name, middle initial, and last name.
4. Select your facility from the provided list, including options like Premier Health Care Management, Cherrywood Nursing and Living Center, and others.
5. Specify your department, such as Premier Admission Center or Evergreen Health and Living Center.
6. Clearly state your specific job title to identify your role.
7. Input your employee hire date and briefly describe the reason for requesting computer access.
8. In the Computer Request section, indicate the software applications you require for your job. Choose from the listed programs relevant to your duties.
9. Provide the computer location and IP address you will use to access the system.
10. Ensure that the form is signed by the department manager or administrator, along with the date of signing.
11. Review the Premier approved software applications section, and note any specific programs to be loaded on your computer.
12. If applicable, fill out the Computer Access Termination section at the end of the form, specifying programs to be terminated and the date of removal.
13. Finalize the form by saving your changes, then download, print, or share the completed form as necessary.

Start completing your EHIPAA Computer Access Request Form online today.