Surgery Applications Request Form

Submitted by : _____________________________

Date: _____________________________

User's Full Name: _____________________________

Division:: _____________________________

Work Location: _______________________

PC’s CRC tag #: _____________________

Applications

_ AIS/ADP (FACS Id) - requires PID

_ Blue-E

_ ChartScript

_ CIS - requires Confidentiality Statement

_ CPOE (Computerized Physician Order Entry)

_ eScription Dictation-requires Electronic Signature Authorization Form

_ Hospital Session: SMS/A2K

_ KRONOS

_ Outlook Calendaring - requires SOM e-mail account

_ PACS

_ Surgery Network Login (file/print sharing) - requires SOM e-mail account

Please return to:

Systems Support

UNC Dept. of Surgery

CB #7050