New Network User Form Check End One First Last Name: Name: Employee Effective #: Date: 7-digit Work Location: Dept: Employee Job Title: ID: CIRCLE ONE OPTION: ES Employee or Other (please explain) Circle Application / Access For IT Department Use Only: Action Add Network Access Add Email Account Add Easy File Purchase or Medical Records (Must submit Easy File User Request Form) – Add FlexDSI (Farnum EHR application/website) Add Allscripts (Medical/Billing) Add Raiser’s Edge (Development) Add PS Financials Expense User – Add PS Financials Expense Approver – Add PS Financials Requisition User – Add PS Financials Requisition Approver – Add PS Financials Report User – Add PS Financials Grant Report User – Comments: Supervisor: Date: Signature Supervisor: Phone: Please print name
New Network User Form Check One End Last Name: First Name: Employee #: Effective Date: Work Location: 7-digit Dept: Job Title: Employee ID: CIRCLE ONE OPTION: ES Employee or Other (please explain) Circle Action Application / Access For IT Department Use Only: Add Network Access Add Email Account Add Easy File – Purchase or Medical Records (Must submit Easy File User Request Form) Add FlexDSI (Farnum EHR application/website) Add Allscripts (Medical/Billing) Add Raiser’s Edge (Development) Add PS Financials – Expense User Add PS Financials – Expense Approver Add PS Financials – Requisition User Add PS Financials – Requisition Approver Add PS Financials – Report User Add PS Financials – Grant Report User Comments: Supervisor: Date: Signature Supervisor: Phone: Please print name
Easter_Seals_New_Network_User_Form.docx