IT Request
Basic Information
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Full Name: |
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Start Date: |
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Cell Phone(for MFA): |
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EMP ID: |
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Job Title: |
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Location: |
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License Type: |
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License Number: |
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Supervisor: |
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Full Time: |
Part Time: |
Rehire: |
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Software
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Wellsky:
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Adobe: |
Forcura: |
SHP: |
Medline: |
Paylocity: |
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CareVoyant:
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RingCentral: |
Trella: |
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Careficient:
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Domain for the email address(i.e. @lchhfamily.com): |
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Email Groups Needed: |
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User to clone for software: |
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Hardware: (Pick only one)
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Laptop Setup:(office staff) |
Tablet Setup: (clinicians) |
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Shipping Address: |
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Phone:
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New Desk Phone: |
Ring Central App: |
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Ring Group to be added to: |
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Locations needed to access:
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BF Weatherford: |
BF San Antonio PD: |
Valley Hospice: |
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BF San Antonio: |
Eternal Faith SA: |
Haven Home Health: |
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BF Wichita Falls: |
Eternal Faith Austin: |
CHC PD PB: |
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BF Graham: |
Fairmont HH: |
CHC HH PB: |
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BF Lubbock: |
Fairmont Hospice: |
CHC PD Miami Lakes: |
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BF New Braunfels: |
CareFirst: |
CHC HH PSL: |
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CHC PD Bonita Springs: |
CHC PD Broward: |
CHC PD ST Pete: |
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CHC HH Broward: |
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CHC PD Tampa: |