ORCF Secure Systems Access Request Form

The Office of Healthcare Programs (OHP) security protocols for accessing the Office of Residential Care facilities (ORCF) Document Management System (TransAccess), the 232 Healthcare Portal, and the OHP SharePoint Page, requires user's Supervisors to request access by completing this form. One form must be completed for each request type and for each individual requiring access.

Access Information

Access Type*

Select

Site Access*

Select

Lender's Name*

Select

Lender Name (Manual Population)*

Lender ID*

Area of Specialty:*

Please select the specialty section of the employee

Select

Internal Access Request Type*

Please select a tool of which the user is requiring access to (one tool per request).

Select

Employee Section*

Please select the section of which the employee is assigned to.

Select or enter value

Other - Explanation

Site Access Type for New Lender

Select

External Access Request Types*

Select

Current Role*

Select

New Role*

Select

Employee Information

Please enter the remainder of the required "*" fields.

First Name*

Name of Employee

Middle Name

Middle Name of Employee

Last Name*

Last Name of Employee

Employee Name as It Appears in IREMS*

Employee Job Title*

Employee H#*

Employee Email*

Employee Work Street Address*

Employee Work City*

Employee Work State*

Employee Work Zip*

Employee Telephone Number*

Supervisor Information

Please complete the remainder of the required "*" fields.

Employee Supervisor's Name*

Employee Supervisor's Title*

Employee Supervisor's E-mail Address*

Supervisor's Recommendation*

Please check this box to recommend user receive access to the requested tool.

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