Get Access Card Request Form.doc

This guide provides users with step-by-step instructions on how to accurately complete the ACCESS CARD REQUEST Form.doc online. Following these instructions will help ensure that your form is filled out correctly and processed efficiently.

Follow the steps to successfully complete the ACCESS CARD REQUEST Form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Fill in your name, starting with your last name followed by your first name and middle initial. Ensure clarity in your handwriting.
3. Provide your Social Security Number (SSN) in the designated field.
4. Enter your job title accurately as it pertains to your role within the organization.
5. Indicate the name of your company or facility in the allotted space.
6. Input your phone number for contact purposes.
7. Select the applicable category by checking either 'Patient Care Provider', 'Vendor', 'Independent Contractor', or 'Other', and specify if 'Other'.
8. If you're a vendor, note the number of access cards requested in the specified area.
9. Select the exterior entrances for which access is being requested by checking the relevant boxes, including 'Loading Docks', 'Everett Tower', and 'Presby Tower'.
10. In the justification section, provide a detailed explanation of your frequency of access and the need for after-hours access.
11. Specify the desired activation period, which can range from 1 to 12 months.
12. Enter the name and department of the OUMC Department Director or Administrator responsible for approving your request.
13. Fill in the name and phone number of the individual to contact when the card is ready.
14. Sign and date the form to validate your request.
15. If required, obtain the necessary approvals from the Chief Administrative Officer and the Medical Staff Services Director.
16. After completing the form, ensure you save your changes. You can then download, print, or share the form as needed.

Complete your ACCESS CARD REQUEST Form online to ensure swift processing of your access needs.