Mar 7, 2017 - This section is to be completed by University of Alberta Administrators/Managers and AHS CMO. Office for account renewals only. Please m...
Faculty of Medicine and Dentistry, University of Alberta Alberta Health Services Netcare Access for Clinical Administrative Assistants – Department of Medicine Cover Sheet This cover sheet document is to be used when requesting Netcare access only for those University employees providing clinical support services to A‐ARP physicians. Please check off actions that are completed.
Full Name of University of Alberta Employee Requesting Netcare Access: (last, first, middle): Month of Birth: Day of Birth: Date of Access Requested: This Netcare account will be suspended after one year from the date listed on the signed AHS Clinical Administrative Assistant Agreement for Alberta Netcare Electronic Health Record Portal Access, if AHS does not receive a renewal cover sheet for this individual.
New Netcare Access Requests This section is to be completed by the University of Alberta Administer/Manager and the AHS CMO Office for new account requests only. Please mark the appropriate tick‐box after it has been verified.
CMO UofA
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Verification that Netcare Access Level listed on the form is “Clinical Level 2” and that it is appropriate for the employee.
AHS privacy and security training is complete and Privacy and Confidentiality Agreement has been signed and received by the CMO Office.
Verification that the above‐named employee is providing support services to physician(s) who are members of the University of Alberta Faculty (please refer to list of physicians attached to the employee’s clinical administrative assistant agreement).
Verification that the above‐named employee is providing support services to physician(s) who are members of an active A‐ARP (please refer to list of physicians attached to the employee’s clinical administrative assistant agreement).
Last Update: 07-Mar-2017 Page 1 of 2
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☐ Verification that the AHS Clinical Administrative Assistant Agreement for Alberta Netcare Electronic Health Record Portal Access has been signed by the above named individual and received by the AHS CMO Office.
Netcare Access Renewals This section is to be completed by University of Alberta Administrators/Managers and AHS CMO Office for account renewals only. Please mark the appropriate tick‐box after it has been verified.
CMO UofA
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☐ Verification that University of Alberta Employee named above still requires Netcare access for the upcoming year.
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☐ Verification that the above‐named employee is providing support services to physician(s) who are members of the University of Alberta Faculty and are on an active A‐ARP.
The undersigned individuals certify that all of the required actions for this request have been completed:
Signed by:
AHS CMO Representative Date
Print Name
University of Alberta Administrator/Manager Date
Print Name
The University of Alberta, Department of Medicine, Administrator/Manager signing this form must be one of the following individuals:
RaeAnne Barkhouse, Administrator Marilyn Bradford, Administrator Karen Doring, Administrator Nadine Dixon, Administrator Zuzana Turakova‐Baran, Administrator Last Update: 07-Mar-2017 Page 2 of 2
Bernadine Dube, Administrator Lilly Siik, HR Partner Susan Tiller, Administrator
