X MultiCare Connect Remote access Send acts to (Epic/Hyperspace) MyPortal (Citrix) website X Windows Log-On (MHS domain account) Other Citrix Applications MultiCare.Org E-mail Account X MultiCare Imaging PACs Needed Pyxis Medstation ____________________________ Lawson ____________________________ Other:__________________________ IMPORTANT: Please explain your business needs for the above selected access types. User Signature: Date: Delegate Name (if Initials: applicable): MHS Sponsor Signature: Kareena Andreas Date Processed: Licensed Entity (Company Manager Signature): Per MHS Policy “Records Management & Retention”, this information and all accompanying material must be kept on file with the sponsoring department for no less than ten (10) years after date of off-boarding for each client. MHS Confidentiality & Use Statement
Send acts to X MultiCare Connect (Epic/Hyperspace) X Windows Log-On (MHS domain account) MultiCare.Org E-mail Account X MultiCare Imaging PACs Pyxis Medstation Lawson Other:__________________________ Remote access MyPortal (Citrix) website Other Citrix Applications Needed ____________________________ ____________________________ IMPORTANT: Please explain your business needs for the above selected access types. User Signature: Date: Delegate Name (if applicable): Initials: MHS Sponsor Signature: Kareena Andreas Date Processed: Licensed Entity (Company Manager Signature): Per MHS Policy “Records Management & Retention”, this information and all accompanying material must be kept on file with the sponsoring department for no less than ten (10) years after date of off-boarding for each client. MHS Confidentiality & Use Statement