Get The Methodist Hospital System Access Request Form 2012-2025

This guide provides clear, step-by-step instructions for filling out The Methodist Hospital System Access Request Form online. Following these instructions will ensure that your access request is processed smoothly and efficiently.

Follow the steps to successfully complete the access request form.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Review the form carefully. Ensure you have a signed TMHS Confidentiality & Information Security Agreement ready to accompany your request.
3. Indicate the hospitals where you have privileges by checking the boxes for each location.
4. Select the type of access you are requesting from the options provided, which includes either modifying existing access or requesting new user access.
5. Fill in your personal details in the required fields, including your name, office address, credentials, office manager, specialty, telephone number, and email address.
6. If applicable, express your preference for obtaining a Methodist email address by checking the relevant box.
7. List any physicians in your practice with whom you have an association by providing their name and medical staff number.
8. Provide your signature and date in the designated areas. If you are completing the form on behalf of another staff member, include the physician’s printed name and their signature as well.
9. For internal processing, ensure that the relevant approving physician’s medical staff number and signatures of authorized agents are completed below the designated line.
10. Once all fields are completed, review the form for accuracy before saving your changes, downloading, or printing the completed form for submission.
11. Fax the completed form to the appropriate number for your location, as listed on the form.

Complete The Methodist Hospital System Access Request Form online today to ensure efficient processing of your access request.