Get Access Request Form - Missouri Department Of Health & Senior ... - Health Mo

Filling out the Access Request Form is a necessary step for individuals seeking access to specific resources within the Missouri Department of Health & Senior Services. This guide provides clear instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete your Access Request Form online.

1. Press the 'Get Form' button to obtain the Access Request Form and open it for editing.
2. In the identifying information section, fill out your social security number, userid, and personal details including your name, job title, and work address. Make sure to specify if you are a contract worker, and provide the name of the contracting agency if applicable.
3. Move on to the action section where you will select the requested action, such as adding or deleting userid access. Specify the effective date for your requested action in the MM/DD/YYYY format.
4. In the access section, provide your email address and indicate whether you also need an internet mail ID by selecting 'Yes' or 'No'. Include any additional comments as required.
5. Proceed to the confidentiality and signature section. Read the statement carefully and ensure you understand the confidentiality requirements. Sign and date the requestor's signature as well as the supervisor/security coordinator's signature and the divisional security officer's signature.
6. After completing all sections of the form, you have the options to save your changes, download a copy for your records, print the form, or share it if necessary.

Complete your Access Request Form online to gain access to vital resources.