MSPHL User Access Request Form

MSPHL User Access Request Form

To request access to the Missouri State Public Health Laboratory (MSPHL) Web Portals, please complete the required fields below and submit your request. Please submit one form per person requesting access.

For organizations requesting access to Human/Clinical and/or Newborn Screening test results, a Memorandum of Agreement (MOA) must be completed and signed by your authorizing representative and returned to the MSPHL. The Informatics team will review your request and verify if we have an active MOA on file. If not, we will reach out to you to initiate the process.

An Attachment A form will need to be completed and uploaded for each user requesting access.

Access to the MSPHL Web Portals is not immediate, please allow 3 to 10 business days for processing access requests.

To receive a copy of your request, please click on the check box next to "Send me a copy of my responses" at the bottom of the form prior to clicking "Submit".

*Please note, this form and accompanying Attachment A will also need to be completed to request removal of user access.

New User Information

First Name*

Last Name*

Middle Initial

Please provide your email address*

For human/clinical and/or newborn screening results, MSPHL requires that the user utilizes an organizational email address, not a personal email address. If this is a concern, please call the MSPHL Informatics Help Desk at 573-522-9560

What is a good contact phone number?*

Phone

Organization/Facility Information

What is the name of your organization?*

It is required to have an Memorandum of Agreement (MOA) on file with the MSPHL for accessing results for Human/Clinical or Newborn Screening results. The team here will verify if your organization has an active MOA on file, if not, we will reach out to you to initiate the process.

What is the last four of your social security number (ssn)?*

Per Missouri Information Technology policies, users who get access to the OpenELIS Web Portal must complete an Automated Access Processing System (ASAP). The last four of your ssn acts as a unique identifier for you if you ever need to reset your account.

Please upload the Attachment A, MSPHL Web Portal Access Request Form.*

An Attachment A form is required for all users requesting access to, or removing access from, MSPHL's Web Portals. Please download and complete the form found and upload it here. No user access request will be processed without this form.

Drag and drop files here or

Send me a copy of my responses

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