FMC Access form

Access Request Form

Name: Full Name Required (Middle name required) *

First

Middle

Last

Birth date *

Email *

Phone # *

Job Title

Access Requested *

• 3M CODING (For 3M hospital coding)
• MEDHOST WebGUI (Business office, Account, Lab, etc.)
• MEDHOST CLINICALS (Patient information, reports)
• MEDHOST EXPERIENCE (Patient Admissions, Inpatient Experience, Physician Experience)
• MEDHOST EDIS/VIEWER (Read only, EDIS patient records, EDIS reports)
• MEDHOST DMS (Patient information archive)
• MEDHOST WEB SQL (Web SQL only)
• MEDHOST Support site (Submitting tickets to MEDHOST)
• MEDHOST BI Tool (Business Intelligence, Quality only)
• ATHENA (Clinic EHR)
• NovaRad (Viewing Images, Physicians only)
• NovaRIS (Radiology Administration only)
• NovaADMIN (Radiology Administration only)
• Case Management (ESS Case Management, For INP, ER only)
• Payment Services (Receiving payments, Admitting, Management)
• CIHQ (Hospital Survey information)
• Metasys (Facility services only)
• HIPPO (Facility services only)
• WorkSight (Time entry, FMC employees only)
• REMOTE SERVER (Remote access to servers, Not related to 3M)

User to Mimic (Who should the new user to be set up like) Not required for 3M users

Company Requesting Access. *

Contact email for additional information *

Additional Information (Additional information)

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