• SASH Staff Member Update Form

  • This information will be put into our SASH Directory and used for system permissions to ensure proper communication with our team and community members.

  • Your Information

    (person completing form)

  •  -
  • What would you like to do?*

  • Enter New SASH Staff Member (this form is also used for new interns)

  • This form is for new SASH Staff ONLY - Are you sure you would like to add a new staff member to ALL systems?*
  • Staff Member Title(s)*

  •  -
  •  -
  • What is their start date?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Staff Member Panel(s)*
  • Select which systems your staff should have access to?
  • Select which systems your Intern should have access to?*
  • How long will the Intern be with the SASH Program?*
  • What is your Intern's expected end date?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Which panels should your Intern have access to?*
  • Choose which of the following trainings you would like for the Intern to be assigned in Relias.  The HIPAA Overview will be assigned to all Interns who will be in FAMCare.

  • Temporary Panel Coverage FAMCare/Bamboo Access

    This form is for exisisting staff who need temporary access to panel(s) and need to be added to FAMCare and/or Bamboo Health. Temporary access meaning 0-3 months.

  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date (0-3 months, end date MUST be entered, if an extension is needed please fill out this form again)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does the staff member need access to Bamboo Health?*
  • What panel(s) does the staff member need access to?*

  • Update Existing SASH Staff Member Information

  • This form is for updating existing SASH Staff Members information such a email, phone, name or position ONLY! Are you sure you want to update existing staff information?*
  • Effective Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Would you like to update your contact information?*
  • What information are you updating?

  • What is staff member's new SASH title/position?
  •  -

  • Update Existing SASH Staff Member Panel(s)

  • This form is for updating existing SASH Staff Members panel (s) information ONLY! Are you sure you want to update an existing staff's panel?*
  • Effective Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Would you like to remove panel(s)?*
  • What panel(s) are you REMOVING?
  • Do you still need temporary access to the panel(s) being removed in Bamboo Health?
  • Until what date do you need this temporary access?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Would you like to add panel(s)?*
  • What panel(s) are you ADDING?
  • Do you have other information to update?

  • Remove Existing SASH Staff Member

  • This form is to remove staff from SASH permanently - Are you sure you want to remove a staff member from ALL systems?*
  • Title of Staff Member to be removed*
  • Title of Staff Member to be removed*
  • Last Day of Employment*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Staff Member's panel(s) to be removed*
  • Will there be someone supporting this panel in your absence?
  • If your staff has access through SASH to VITL, your VITL Security Officer has deactivated them from VITL by submitting the VITL User Management Form.*
  • Any account access obtained through SASH for a hospital's EMHR (Electronic Medical Health Record) has been deactivated/removed.*
  • Access to the staff person's Barracuda account has been disabled by your organization's IT department via a manual password change (requires access to the leaving staff person's email inbox).*

  • Temporary Leave of Existing SASH Staff Member

    This form is for SASH Staff Members going on temporary leave from their position for one or more months

     

  • Title of Staff Member going on Temporary Leave*
  • Start Date of Temporary Leave*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date of Temporary Leave (Approximation is ok, submit another TMUF for any end date changes)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you want staff member's accounts inactivated while on leave?*
  • Will there be someone supporting this panel in your absence?*
  • Staff Member's panel(s)*
  • Should be Empty: