[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-565288-105":3,"detail-sidebar-cat-1-en-105":84,"doc-detail-565288-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":77,"head_meta":79,"extra_data":81,"updated_unix":83},105,"en","information-access-request-form-epic-access-new-id-update-existing-id-delete-existing-id","INFORMATION ACCESS REQUEST FORM EPIC ACCESS - New ID - Update Existing ID - Delete Existing ID","","Information Access Request Form EPIC Access用于申请与管理对University Health System相关信息系统的访问权限。表单要求填写请求人姓名、部门、网络登录/用户ID、联系电话及凭证信息，并选择访问类型与角色范围（如Review Only、Coder、Billing、DataSearch等）。同时提供更新或删除既有ID的选项，并包含给办公室使用的完成日期与签署信息。文件还附带保密协议，说明账号与密码唯一性、离开工作站需终止会话、遵守保密义务及违规可能导致的权限撤销与纪律处分。",{"@graph":14,"@context":76},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/information-access-request-form-epic-access-new-id-update-existing-id-delete-existing-id/565288/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/information-access-request-form-epic-access-new-id-update-existing-id-delete-existing-id/565288.png","ImageObject",442,249,{"name":42,"@type":43},"Mary Man","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-18","2026-10-13",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68,72],{"name":59,"@type":60,"acceptedAnswer":61},"需要填写哪些关键信息来提交信息访问请求？","Question",{"text":62,"@type":63},"需填写请求人姓名、部门、网络用户ID、员工职位、主要工作地点、RC number与联系电话/分机，以及凭证类型等，并选择适当的访问范围。","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"表单如何区分“申请新ID”“更新现有ID”和“删除现有ID”？",{"text":67,"@type":63},"在EPIC Access表单部分有“ISSUE NEW ID”“UPDATE EXISTING ID”“DELETE EXISTING ID”选项，并要求勾选或选择对应的处理方式与授权签署信息。",{"name":69,"@type":60,"acceptedAnswer":70},"保密协议中对账号与密码有哪些核心要求？",{"text":71,"@type":63},"协议强调userid与密码组合唯一且作为电子签名等效；需认识到所有在该账号下的行为由本人负责，并在离开工作站前终止会话。",{"name":73,"@type":60,"acceptedAnswer":74},"若违反保密或访问条件会产生什么后果？",{"text":75,"@type":63},"文件说明违反条件可能导致计算机访问被撤销、员工被终止雇用、非员工被拒绝医院访问以及其他纪律处分。","https://schema.org",{"og:url":32,"og:type":78,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":80,"canonical":32},"index,follow",{"doc_id":82,"site_id":7},565288,1792310044,{"code":4,"msg":85,"data":86},"success",[87,92,97,102,107,112,116,121,126],{"id":88,"doc_module":22,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},11,"Presentations",90,"presentations",{"id":93,"doc_module":22,"doc_module_name":25,"category_name":94,"show_sort_weight":95,"slug":96},12,"Resumes",80,"resumes",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":100,"slug":101},14,"Invoices",70,"invoices",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},15,"Posters",60,"posters",{"id":108,"doc_module":22,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},16,"Social Media",50,"social-media",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":114,"slug":115},17,40,"forms",{"id":117,"doc_module":22,"doc_module_name":25,"category_name":118,"show_sort_weight":119,"slug":120},18,"Letters",30,"letters",{"id":122,"doc_module":22,"doc_module_name":25,"category_name":123,"show_sort_weight":124,"slug":125},21,"Paper Templates",5,"papers-templates",{"id":127,"doc_module":22,"doc_module_name":25,"category_name":128,"show_sort_weight":4,"slug":129},158,"General","general-158",{"code":4,"msg":85,"data":131},{"doc_id":82,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":22,"category_id":113,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":22},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","INFORMATION ACCESS REQUEST FORM  \nPLEASE SUBMIT THIS COVERSHEET WITH ALL ACCESS REQUESTS-BOTH NEW IDS AND UPDATES Please complete all of the information below. Incomplete forms will be rejected.  \nTODAY’S DATE:   START DATE:    \nUSER’S NAME:    \n__________________________________________________________  \nLAST NAME FIRST NAME MIDDLE INITIAL  \nLAST 4 DIGITS OF THE USER’S SSN:    \nDEPARTMENT NAME:    \nNETWORK USER ID:    \nEMPLOYEE’S TITLE:    \nPRIMARY WORK LOCATION:  (UH, UHCD, UFHCN, UFHCNW, UFHCSW, UFHCSE, UHBC, UCCH, DHCS, UTHSC, CTRC, UPG, ETC.)  \nRC NUMBER:  \n______________  \nPHONE/PAGER NUMBER:   EXT.   \nCREDENTIAL: __________ (MD, PA, MS3, MS4, RN, CRRT, LVN, etc.)  \nPROVIDER ID\\#:  DEA\\#: DPS\\#:  State Lic \\#:  HOUSESTAFF DEA\\#: AM1472579   DPS\\#: 10046768   State Lic \\#:  FACULTY HOUSESTAFF/RESIDENT Military Rotator ( to )  \nALLIED HEALTH W/  PRESCRIPTIVE AUTHORITY  \nVisiting Medical Student ( to ) Authorization letter from UT Registrar’s office must be attached. Requests without authorization will be rejected.  \n Contract/temporary ( to )  \nResearcher or Research Monitor (  to ) for IRB\\#   \nAUTHORIZATION:  \n(DIRECTOR/SUPERVISOR)  \nPRINT:   \nNAME TITLE  \nSIGNATURE:   \nE-MAIL ADDRESS FOR NOTIFICATION:  (not required if your email [is @uhs-sa.com](is @uhs-sa.com))  \nHave any questions? Call Data Security at (210) 358-0640. You can scan and email completed access requests to [DataSecurityScannedRequests@uhs-sa.com](DataSecurityScannedRequests@uhs-sa.com), fax them to (210) 702-4010, or route them to us at MS124-1.  \nRev. 07/14  \nINFORMATION ACCESS REQUEST FORM EPIC ACCESS  \nUSER’S NAME:    \nNETWORK LOGIN ID:    \nSUPERVISOR’S SIGNATURE:    \nISSUE NEW ID  \n\n|  | UPDATE EXISTING ID |  |\n| --- | --- | --- |\n\nDELETE EXISTING ID  \nSELECT THE APPROPRIATE:  \n Review Only (Can review charts but not edit data)  \n Review Only with Reporting (Can review charts but not edit data; report access)  \n Coder  Billing  MedData  DataSearch  Trend  Optum  \n UT Surgeon Clinical Support Staff  UT Surgeon Administrative Support Staff  \n IR Radiologist  Radiologist  Breast Imaging Radiologist  \n Radiology Physician Assistant  Cardiology Nurse  Cardiology LVN  \n Cardiology MA  Cardiology Clinic Scribe  Cardiology Practice Manager  \n Cardiology Practice Supervisor  Cardiology Benefits Coordinator  Front Desk  Referral Coordinator  Concierge/Greeter  Ophthalmology Tech  \n Ophthalmology Clinic Manager  Ophthalmology Front Desk  Sr Admin Asst  Admin Assist Data Coordinator  Nurse Coordinator  Transplant Biller  South Texas Renal Group  Texas Liver Institute  CFL  Oncology Nurse  Orthotist/Prosthetist  Emergency Service Project Manager  \n Medical Student  Nurse Practitioner Student  Nursing Student  \n Pharmacy Student  Physical Therapy Student  Occupational Therapy Student  Speech/Language Pathology Student  Respiratory Therapy Student  \nFOR OFFICE USE:  \nDATE COMPLETED:  COMPLETED BY:   \nRev 03/2020  \nUNIVERSITY HEALTH SYSTEM  \nCONFIDENTIALITY AGREEMENT  \nI, the undersigned, hereby acknowledge receipt of a 4. Issuance of New Userid and Password. If I  \nuserid and password giving me access to the Hospital have any reason to believe that the confidentiality of Information System of the University Health System, my userid and password has been compromised, IBexar County, Texas (hereafter referred to as the will notify the Data Security Administrator  \nUniversity Health System) computer system. I immediately so that the suspect userid and password  \nunderstand and acknowledge that this userid and may be deleted and a new userid and password  \npassword combination is unique to me and is the assigned to me.  \nelectronic equivalent of my signature, with no  \ndifference in liability existing between my written 5. Responsibility for Self. I recognize that I am  \nand electronic signatures. responsible for all actions performed at a workstation  \nactivated with my userid and password; therefore, I  \nI further understand that this userid and password will termina","cbCaig8NytNPMXo6","https://ap.wps.com/l/cbCaig8NytNPMXo6","pdf",219758,"English","# INFORMATION ACCESS REQUEST FORM\n## USER INFORMATION\n## ACCESS REQUEST TYPES\n## FOR OFFICE USE\n## CONFIDENTIALITY AGREEMENT","[{\"question\":\"需要填写哪些关键信息来提交信息访问请求？\",\"answer\":\"需填写请求人姓名、部门、网络用户ID、员工职位、主要工作地点、RC number与联系电话/分机，以及凭证类型等，并选择适当的访问范围。\"},{\"question\":\"表单如何区分“申请新ID”“更新现有ID”和“删除现有ID”？\",\"answer\":\"在EPIC Access表单部分有“ISSUE NEW ID”“UPDATE EXISTING ID”“DELETE EXISTING ID”选项，并要求勾选或选择对应的处理方式与授权签署信息。\"},{\"question\":\"保密协议中对账号与密码有哪些核心要求？\",\"answer\":\"协议强调userid与密码组合唯一且作为电子签名等效；需认识到所有在该账号下的行为由本人负责，并在离开工作站前终止会话。\"},{\"question\":\"若违反保密或访问条件会产生什么后果？\",\"answer\":\"文件说明违反条件可能导致计算机访问被撤销、员工被终止雇用、非员工被拒绝医院访问以及其他纪律处分。\"}]","INFORMATION ACCESS REQUEST FORM EPIC ACCESS - New ID - Update Existing ID - Delete Existing ID | PDF",1791850651]