Get Wv River Park Hospital Information Systems Access Request Form 2008-2025

This guide provides clear and supportive instructions on how to accurately complete the WV River Park Hospital Information Systems Access Request Form online. By following these steps, users will be able to effectively submit their requests for access.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the applicant's last name in the designated field. Ensure this is printed clearly for identification purposes.
3. Next, fill in the applicant's first name in the appropriate field, also ensuring clarity.
4. In the following field, provide the applicant's middle initial or indicate 'NA' if not applicable.
5. Enter the applicant's phone number, including the extension if available, to facilitate communication.
6. Fill in the date of birth of the applicant in the designated space.
7. Specify the department number associated with the applicant.
8. Input the name of the department where the applicant will be working.
9. Provide the applicant's Social Security Number securely in the designated field.
10. Indicate the job function or title of the applicant to clarify their role.
11. If the applicant is replacing a terminated employee, list the name of the individual being replaced.
12. Identify another employee who shares the same job function as the applicant.
13. If the applicant is not an employee, provide the contractor's name and address in the appropriate section.
14. For contractors and vendors, provide the end date of engagement or contract where applicable.
15. Select the systems to which the user needs access. Options include Lawson, Meditech, Outlook Email, among others. Check all that apply.
16. Indicate whether the user requires update or inquiry access for the systems selected.
17. If there are any additional systems required not listed, specify them in the provided space.
18. Finally, ensure all necessary signatures are collected, including the manager’s and the local security coordinator’s, along with the dates.
19. Once completed, save changes, and proceed to download, print, or share the form as needed. Ensure to fax the completed form to the number provided.

Take action now and fill out the WV River Park Hospital Information Systems Access Request Form online.