MOHSAIC Inventory System Training Package for Hospitals ... - starrs

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MOHSAIC training User Access In order to be trained, users must be set up with a USER ID. Typical questions about the completing the form: Write legibly: I will be e-mailing them their USER ID when I receive it and have to be able to read their e-mail address! This is critical as they will be given instructions on how to log in prior to the training. This ensures that we can get everyone into the system prior to the training date and any glitches worked out so that there are no hold ups the day of the training. SSN: This is required by our ITSD. Without it, no USER ID can be issued and they cannot be trained. ALL FORMS REMAIN CONFIDENTIAL. Only my ITSD contact and I see this form. Signatures: Even if the head of a department is being trained, that person's supervisor still needs to sign the form. Agency: This is the name of the hospital Blocks to check: Add User Add Access Roles: SNS County Administrative Management: Access to SNS Inventory, excludes receipt of SNS shipment (second box in first section) SNS Local Public Health Staff - Permission to request SNS supplies (last box in second section) E-mail address required for this role: may be different than the e-mail of the user. *identify agencies where you enter data: if this is a large hospital complex with satellite sites, indicate the site where the data will be entered.
MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES (DHSS) CENTER FOR EMERGENCY RESPONSE & TERRORISM P.O. Box 570, Jefferson City, MO 65101-0570 Telephone: (573) 526-4768 FAX: (573) 522-8636 STRATEGIC NATIONAL STOCKPILE USER ACCESS REQUEST PLEASE SEND TO THE ABOVE ADDRESS OR THE FAX NUMBER PLEASE PRINT IDENTIFYING INFORMATION Name (Last, First, MI) Agency/Division/Center * Office Address (Street, City, Zip) Social Security Number Office Telephone E-Mail Address Office Fax ACTION REQUESTED ADD USER DELETE USER NAME CHANGE (Former Name) ADD ACCESS DELETE ACCESS TRANSFER ROLES FOR GENERAL ACCESS TO SNS SELECT ONLY ONE OF THESE ROLES SNS State Administrative Management: Access to SNS Inventory, includes receipt of SNS shipment. SNS County Administrative Management: Access to SNS Inventory, excludes receipt of SNS shipment SNS View Only: View SNS Inventory ROLES FOR INVENTORY REQUESTS SELECT ONLY ONE OF THESE ROLES SNS Disaster Situation Room Coordinator – Permission to approve requests for SNS supplies. SNS Inventory Manager – Permission to fill approved orders for SNS supplies SNS Local Public Health Staff – Permission to request SNS supplies. Email Address Required for this Role. Email Address ___________________________________________________ *Identify agencies where you enter data: COMMENTS: SECURITY STATEMENT/APPROVALS I, the undersigned, an employee of the State of Missouri or authorized user of Department data, understand that approval and assignment of the requested ID or approval of the requested change enables me to access the resources which, by law, must be utilized only in the performance of my assigned duties. Therefore, I agree to make no inquiries or updates which are not required in the performance of my official duties. I understand that state and federal statutes require confidentiality of information and provide penalties for unauthorized access, use and/or disclosure of information. Violations or disclosures on my part may result in disciplinary action that could be one or all of the following: (1) suspension, (2) civil court and (3) dismissal. I agree to keep confidential all information made available to me in the performance of my official duties. In addition, I agree not to divulge or share my password with anyone. USER SIGNATURE DATE SUPERVISOR SIGNATURE DATE Department Use Only DIVISION/PROGRAM SIGNATURE DATE DIVISION/PROGRAM SIGNATURE DATE DIVISION/PROGRAM SIGNATURE DATE DIVISION/PROGRAM SIGNATURE DATE MO 580-2419E (6-05)
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MOHSAIC Inventory System Training Package for Hospitals ... - starrs

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