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| # | Location | File | Last Modified |
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| 1 | CUI-v2.5.0-release-source.zip\utilities\templates | CPP_Access_Request_Form.xlsx | Fri Mar 23 17:02:06 2018 UTC |
| 2 | CUI-v2.5.0-release-source.zip\utilities\templates | CPP_Access_Request_Form.xlsx | Wed May 16 15:52:02 2018 UTC |
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| 1 | SHEET: Ins tructions | |
| 2 | Community Care Porta l | |
| 3 | Access Req uest Form | |
| 4 | Instructio ns, | |
| 5 | ||
| 6 | 1. Fill ou t the Acce ss Request Form tab as complet ely as pos sible. Fie lds with a n asterisk (*) are r equired. Do not re move heade r or examp le rows. D o not chan ge workshe et order., | |
| 7 | ||
| 8 | 2. Be sure to indica te which r ole(s) are required and approv ed for a p articular user. At l east one r ole must b e selected per user. , | |
| 9 | ||
| 10 | 3. Email t he complet ed file to
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| 11 | ||
| 12 | ||
| 13 | ||
| 14 | ||
| 15 | SHEET: Acc ess Reques t Form | |
| 16 | First Name * | |
| 17 | *Required, Last Name* | |
| 18 | *Required, Email* | |
| 19 | *Required, Role* | |
| 20 | Select VHA Coordinat or or Comm unity Prov ider from drop-down list.,NPI | |
| 21 | **only Com munity Pro viders nee d to enter their NPI .,Notify u ser via em ail? | |
| 22 | **optional , if blank defaults to yes,VHA Coordinat or,Communi ty Provide r, | |
| 23 | (Example ) | |
| 24 | John,Smith , PII ,VHA Coord inator,123 4567891,No , | |
| 25 | ||
| 26 | ||
| 27 | ||
| 28 |
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