RADIOLOGY INFORMATION SYSTEM (RIS) INFORMATION SYSTEM (RIS) ACCOUNT REQUEST FORM. If you are unclear...
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RADIOLOGY INFORMATION SYSTEM (RIS) ACCOUNT REQUEST FORM If you are unclear about any field below, call the Service Desk at 1-888-316-7446 or (306) 337-0600. The Service Desk will complete the request within five business days from receiving the request. Return to: Fax Number: 306-781-8480 Email: [email protected] February 2018 New User Change in User Type Inactivate User Type of request (check one): 1. User Information Date Access Required: Working Title (Function): Work Phone #: User's Full Name (Printed): Email Address: 2. Environment: 3. Account Information: Does the User have an account to log on to the Regional Health Network? Yes, please provide the login ID: No, please submit an Access and Network Account Authorization Form. No, network account needed. S.I.P.P.A Remote Radiologist (does not use eHS PS360) CPSS # for PS360: 4. Regional Access (check Add or Remove for all applicable facilities) Cypress Add Remove Cypress Regional Hospital - Swift Current Herbert & District Integrated Facility Leader Integrated Facility Shaunavon Hospital & Care Centre Add Remove Southwest IHC Facility - Maple Creek Assiniboia Union Hospital Add Remove Five Hills Dr. F.H. Wigmore Regional Hospital - Moose Jaw Add Remove St. Joseph's Hospital - Gravelbourg Heartland Add Remove Biggar Hospital and District Health Centre Davidson Health Centre Kerrobert Integrated Health Centre Kindersley Hospital and District Health Centre Add Remove Rosetown Health Centre Add Remove Kelsey Trail Athabasca Health Facility - Black Lake Carrot River Health Centre Hudson Bay Health Care Facility Kelvington and Area Hospital Porcupine Carragana Hospital Melfort Hospital Nipawin Hospital Add Remove Tisdale Hospital Add Remove Keewatin Yatthé Add Remove St. Joseph's Health Centre - Ile a la Crosse La Loche Health Centre La Ronge Health Centre Add Remove Mamawetan Churchill River Unity and District Health Centre Production EFQ R1Q Outlook and District Health Centre
Transcript of RADIOLOGY INFORMATION SYSTEM (RIS) INFORMATION SYSTEM (RIS) ACCOUNT REQUEST FORM. If you are unclear...
RADIOLOGY INFORMATION SYSTEM (RIS) ACCOUNT REQUEST FORM
If you are unclear about any field below, call the Service Desk at 1-888-316-7446 or (306) 337-0600.The Service Desk will complete the request within five business days from receiving the request. Return to: Fax Number: 306-781-8480Email: [email protected]
February 2018
New User Change in User Type Inactivate UserType of request (check one):1. User Information
Date Access Required:Working Title (Function):
Work Phone #:User's Full Name (Printed):
Email Address:
2. Environment:3. Account Information:Does the User have an account to log on to the Regional Health Network?
Yes, please provide the login ID:
No, please submit an Access and Network Account Authorization Form.
No, network account needed. S.I.P.P.A
Remote Radiologist (does not use eHS PS360) CPSS # for PS360:
4. Regional Access (check Add or Remove for all applicable facilities)CypressAdd Remove
Cypress Regional Hospital - Swift CurrentHerbert & District Integrated FacilityLeader Integrated Facility
Shaunavon Hospital & Care CentreAdd Remove
Southwest IHC Facility - Maple Creek
Assiniboia Union Hospital
Add RemoveFive Hills
Dr. F.H. Wigmore Regional Hospital - Moose JawAdd Remove
St. Joseph's Hospital - Gravelbourg
HeartlandAdd Remove
Biggar Hospital and District Health CentreDavidson Health CentreKerrobert Integrated Health Centre
Kindersley Hospital and District Health CentreAdd Remove
Rosetown Health Centre
Add RemoveKelsey Trail
Athabasca Health Facility - Black Lake
Carrot River Health CentreHudson Bay Health Care Facility
Kelvington and Area Hospital
Porcupine Carragana HospitalMelfort Hospital Nipawin Hospital
Add Remove
Tisdale Hospital
Add RemoveKeewatin Yatthé
Add Remove
St. Joseph's Health Centre - Ile a la CrosseLa Loche Health Centre
La Ronge Health CentreAdd RemoveMamawetan Churchill River
Unity and District Health Centre
Production EFQ R1Q
Outlook and District Health Centre
February 2018
Prince Albert ParklandAdd Remove
Parkland Integrated Health Centre - ShellbrookSpiritwood & Distract Health CentreVictoria Hospital - Prince Albert
Add Remove
Battlefords Union Hospital - North BattlefordAdd RemovePrairie North
Lloydminster Hospital
Add Remove
Regina Qu'AppelleAdd Remove
All Nations Healing Hospital - Fort Qu'AppelleBalcarres Integrated Care Centre
Broadview Union HospitalIndian Head Union Hospital
Add Remove
Southeast Integrated Care Centre - MoosominSt. Joseph's Integrated Care Centre - Lestock
Add Remove
Saskatchewan Cancer Agency
SCA SPBC ReginaSCA SPBC Saskatoon
SCA SPBC Mobile BusAdd Remove
Maidstone Health Complex
Meadow Lake HospitalRiverside Health Complex - Turtleford
Pasqua Hospital - ReginaWascana Rehabilitation Centre - Regina
Wolseley Memorial Union
Sun Country
Arcola Health CentreGalloway Health Centre - Oxbow
Redvers Health CentreKipling Integrated Health Centre
Add RemoveWeyburn General Hospital
Radville Marion Health Centre
SunriseAdd Remove
Canora HospitalKamsack Hospital & Nursing Home
St. Anthony's Hospital - Esterhazy
Add RemoveYorkton Regional Health CentreSt. Peter's Hospital - Melville
SaskatoonAdd Remove
Royal University Hospital - SaskatoonSaskatoon City HospitalSt. Paul's Hospital - SaskatoonHumboldt District Health Complex
Add Remove
Wadena HospitalWatrous Hospital
Rosthern Hospital
Lanigan HospitalWynyard Integrated Hospital
DBC: 5. User Type Requested (select only one):
RadNet:
Hybrid:
eHealth:
Other(please specify):
* need to add to Radiology Technologist User Group** need to add to Radiologist User Group
St. Joseph's Hospital - Estevan
General Hospital - Regina
Add Remove
Charge Services*RadNet*
Scheduling ManagementHealth Records
ProxySupervisor*
ClerkHealth Records ClerkMammography Technologist*Nurse
Obstetrician*Radiologist (fill out section 6 if selected)** Radiology Technologist*Read Only Office
Transporter
Office
Office Plus
Porter
Tech*
Tech Plus*
Data Management Service Desk
February 2018
6. Radiologist InformationRadiologist Resident Remote Radiologist (does not use eHS PS360)
Allow proxy by - list all radiologists that can proxy for the user listed (attach list if needed):
Allow proxy for - list all radiologists that the user listed can proxy for (attach list if needed):
7. Service AuthorizationI acknowledge that the User is permitted access to the selected services.
Manager/Supervisor (if applicable)
Name:(please print)
Date (YY/MM/DD)
Signature:
Signature:
Date (YY/MM/DD)
Name:
Authorized Approver (required):
(please print)
If you need the name of an Authorized Approver, please call the Service Desk 1-888-316-7446 or (306) 337-0600. The most recent version of this form can be downloaded at http://www.ehealthsask.ca/forms.
NOTE: All SHA requests must be sent from the Approver's SHA email account to [email protected].
