Epic Hyperspace Access Request Form: Voluntary Office Staff

Epic Hyperspace Access Request Form: Voluntary Office Staff

Please complete the form below for Epic Hyperspace access.

Epic Hyperspace is given to offices of physicians with medical staff privileges and/or admitting privileges. We allow each physician to grant two of their office staff members access to Hyperspace. An access request form is required separately per user.

The Epic Access Legal Site Agreement must be signed by a physician prior to access being granted. Once you submit the form below we will email the physician the legal site agreement for signature, initiate your account creation and upon completion of your required training Epic Hyperspace access will be granted.

Thank you,

Providerservices@nyp.org

Website: https://epictogetherny.org/VoluntaryProviders/Pages/default.aspx

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User Information

Please answer this section based on the person who is needing Epic access.

Primary Campus*

Select the main campus you/user send patients to.

Select

Additional Campuses

Select all other campuses that you/user send patients to (in addition to the primary campus).

Select

Last Name*

Enter Last name of user needing access

First Name*

Enter First name of user needing access

Email*

Enter your direct email address - not a shared office email please.

Mobile Phone #*

Enter your personal or office mobile phone number. This is used for your DUO enrollment required for Epic access.

Is your mobile phone an Android or iPhone?*

Android

iPhone

Role*

Administrator

Office Manager

Office Assistant

Scheduling Coordinator

DOB*

We use this field to identify users in the case that you previously had an existing account, therefor we not create new.

Legal Agreement Information for Access

Legal Agreement must be signed by a physician only.

Physician Name*

Please enter the FIRST and LAST name of the physician who will be signing the Legal Site Agreement for your access.

Physician NPI #*

Physician Email*

Please enter the email of the physician who will be signing the Legal Site Agreement for your access.

Physician Mobile #*

Please enter the physicians NPI # who will be signing the Legal Site Agreement for your access.