AHPL Badge Request

AHPL Badge Request
What do you need?*
Badge Type*

Adventist Health AssociateTravelerHome HealthAgency StaffOther
Name*

First NameLast Name
When was your badge lost/damaged?*

MonthDayYear
Date
Reason(s) for Replacement*

Name ChangeDepartment ChangeTitle/Job Position ChangeBadge Type ChangeCredentialsOther
Please Input New Change(s)*
(Name Change, Dept. Change, Title Change, Badge Type Change)
It is required for you to return your old badge for replacement
Please Allow 2-4 business days for badge replacement.
Preferred Name
Department*
Job Title*
Required Credentials* (if applicable)
Please select photo uploading option:*
Please make sure it is a headshot with solid background
Upload Photo for Badge*

Browse Files

Cancelof
Take Photo
Additional Notes
Which Access are you missing?*

Door Access EntirelyTime Clock AccessAreas of the Hospital Needed for Job DutyOther
Please Input your Badge #*
What areas of the Hospital?*
If you aren't sure, it would be helpful to list someone you know who has the access you need.
Please allow 24hrs for request to process.
Please allow 3-5 business days for New Hire Badge to be ready.
If you left your badge behind, please make attempts to retrieve it.

- creating a new badge takes time as it will be put into badge request que and activating the badge completely takes 24hrs

- at this time, there are no 'loaner badges' offered

Best option is to retrieve the left behind badge, if you are sure that it is missing, please click to go 'back' and select 'lost/damaged badge' option instead
Email*
example@example.com
Should be Empty: