New User SARF
Manager's Full Name
Manager's Email
example@example.com
Manager's Extension
Single/Multiple User SARF
Single
Multiple
Employee Information
*
Employee's Full Name
Please include Middle Name if known
Employee's Entity
JNH
JGSAS
RH
SHHHC
WADH
CJL
Employee's Department
Employee's Title
Employee Credentials
Type of Hire
Internal
Internal - REHIRE
External
Student
Volunteer
Assigned to Unit
A1
A2
C1
C2
NY
Sossin
AL
GL
N/A
Orientation Date
Date User Will Begin Using Access
*
System Access
*
Badge
Network
Outlook
AOD
PCC
HCF
AllScripts
RFMS
Square
Office Phone
AOD Access Details
PCC Access Details
Folders
Activity Department
Administrator
Admission Team
Assisted Living
Case Management
Contracts
COO
Corporate Compliance
Development
Emergency Preparedness
End of Life Care Training
Environmental
Falls Report
Finance
Food Service
HIPAA Security
HR Staff
ID Badge
iMac
Insurance Cards
IS
Job Descriptions
Managed Care & VA
Manager's Guide
MDS
MMQ
Nursing
Orientation
Policies
Position Control
Public
Ruth's House
Safety Committee
Senior Staff
Social Services
Spectrum
Staff Ed
Transportation
Volunteers
Workers Compensation
Distribution Lists
*All JGS Users
**All JGS Nurses
*All Dept Heads
*All JNH Nursing Staff
*All RH Staff
ADH Face Sheet
Admission Team
AOD User Group
Assisted Living
Bed Census
Care Plan Team
Case Management
Census
Clinical SARF Notification
Development
Donations
Drug Alert
Employee Activity Comm.
Executive
Finance Department
Food Service
Function Form Requests
HIPAA Group
Hospice Admission Group
Hospice Staff
Human Resources
ISVM
JGS Referral Group
JGS Server Room
JNH Face Sheet
JNH QI Committee
JNH Resident List (To)
JNH-Condolences
Nursing Staff
PCC Users
Position Control
Purchasing Committee
Rehab Group
RH Census
RH Resident List (To)
Ruth's House
Safety Committee
SARF Requests
Senior Staff
SHHC Business Office
SHHC Census
SHHC Staff
Social Services
Spectrum Home Health
Square
Temp Alert
Weekend On-Call
Groups
A1 Care Plans
A2 Care Plans
Administration
Admission Team
ALL_JGS_USERS
AOD_USER_GROUP
Assisted Living
C1 Care Plans
C2 Care Plans
Case Management
Contracts
Customer Service Committee
Development
Donations
Drug Alert
EmailOnly
Emergency Preparedness
Engineering Group
Environmental
Executive
Falls Reports
Finance Department
Food Service
HIPAA Group
Hospice Staff
Human Resources
ID Badge
iMac_Users
Insurance Cards
IS Coordinators
Job Descriptions - ADH
Job Descriptions - AS
Job Descriptions - JNH
Job Descriptions - RH
Job Descriptions - SHHHC
Managed Care VA
Manager Guide folder
Marketing Group
Nursing Staff
NY Care Plans
OASIS-JNH
PaperCut
PCC User Group
Photos
Position Control
Purchasing Committee
Recruitment Report
Referral Tracking Group
REPS leads group
Ruth's House
Safety Committee
SeniorStaff
Social Media Committee
Social Services
Spectrum Home Health Care
Support Services
Transportation Group
VPN_Access
Extension
Name to appear on the phone
Employee needs access to previous user's
Email
O Drive
Name of Previous Employee
Comments
Submit
Date SARF Completed
Completed by
User ID
ITD Ticket Number
Should be Empty: