Authorization Form
HCF Family of Companies Access
New Employee
Position Change
Name Change
Provider Access
Point Click Care
Name
*
First Name
Middle Name
Last Name
Facility
*
Job Title / Department
*
Info:
*
(HCF [all caps] + Facility Code + Last 4 digits of SS#)
Check the following applications you will be using (HCF Employees only)
*
Point Click Care
Email
Kronos
QIES Submission
Supply Hawk
Zix Email Encryption
Other
Signature
*
Date
-
Month
-
Day
Year
Date
Administrator
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: