MEDICAL IMAGING ACCOUNT REQUEST FORM (RIS - PACS - PS360) If you are unclear about any fields below, call the Service Desk at 1-888-316-7446 or 306-337-0600. The Service Desk will complete the request within five business days from receiving the request. Return to: Fax Number: 306-781-8480 or Email: [email protected]End User Information May 2018 - Page 1of 3 For Medical Imaging Professionals of the Saskatchewan Health Authority (SHA), the Saskatchewan Cancer Agency, or Private Practices that require access to Radiology Information System (RIS), Picture Archiving and Communications System (PACS), and Powerscribe 360 (PS360). A network account is required if not already provisioned. Type of request (check one): New User Change in User Type Remove User's FIRST name LAST name: Email Address: CPSS#: Environment: Primary SHA Facility Name and Location: Production EFQ R1Q Network Account Username: Network Account Required Work Place Information Private Practice Name and Location: Technologist Technologist Super User Film Librarian Health Privacy Analyst Radiologist Point of Care Provider Point of Care Provider (iExport) Health Data Management Health PACS Administrator (BA and Apps Only) Surgeon Specialist / ER Physician Service Desk SHA System Admin VPN ACCESS: Yes No Site Admin Transcription / Editor Other (please specify): Radiologist / Attending Resident / Fellow DBC: Discern Charge Services* RadNet* Scheduling Management Health Records Supervisor* RadNet: Obstetrician* Clerk Transporter Radiology Technologist* Mammography Technologist* Radiologist** Health Records Clerk Read Only Office Nurse Hybrid: Tech Plus* Porter Office Tech* Office Plus eHealth: Service Desk Data Management Other Access Type (please specify): * need to add to Radiology Technologist usergroup ** need to add to Radiologist usergroup Transcription Charge Services* Film Librarian Hybrid Tech Plus* PACS Access Required (select only one) PS360 Access Required (select only one) RIS Access Required (select only one) Work Phone #: Date Access Required: (MM/DD/YY)
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MEDICAL IMAGING ACCOUNT REQUEST FORM
(RIS - PACS - PS360)If you are unclear about any fields below, call the Service Desk at 1-888-316-7446 or 306-337-0600. The Service Desk will complete the request within five business days from receiving the request. Return to: Fax Number: 306-781-8480 or Email: [email protected]
End User Information
May 2018 - Page 1of 3
For Medical Imaging Professionals of the Saskatchewan Health Authority (SHA), the Saskatchewan Cancer Agency, or Private Practices that require access to Radiology Information System (RIS), Picture Archiving and Communications System (PACS), and Powerscribe 360 (PS360). A network account is required if not already provisioned.
Type of request (check one): New User Change in User Type Remove
St. Joseph's Health Centre - Ile a la CrosseLa Loche Health Centre
La Ronge Health CentreAdd RemoveMamawetan Churchill River
Unity and District Health Centre
Prince Albert ParklandAdd Remove
Parkland Integrated Health Centre - ShellbrookSpiritwood & Distract Health CentreVictoria Hospital - Prince Albert
Add Remove
Battlefords Union Hospital - North BattlefordAdd RemovePrairie North
Lloydminster Hospital
Add Remove
Regina Qu'AppelleAdd Remove
All Nations Healing Hospital - Fort Qu'AppelleBalcarres Integrated Care Centre
Broadview Union HospitalIndian Head Union Hospital
Add Remove
Southeast Integrated Care Centre - MoosominSt. Joseph's Integrated Care Centre - Lestock
Maidstone Health Complex
Meadow Lake HospitalRiverside Health Complex - Turtleford
Pasqua Hospital - ReginaWascana Rehabilitation Centre - Regina
Wolseley Memorial Union
SaskatoonAdd Remove
Royal University Hospital - SaskatoonSaskatoon City HospitalSt. Paul's Hospital - SaskatoonHumboldt District Health Complex
Add Remove
Wadena HospitalWatrous Hospital
Rosthern Hospital
Lanigan HospitalWynyard Integrated Hospital
General Hospital - Regina
Saskatchewan Cancer Agency
SCA SPBC ReginaSCA SPBC Saskatoon
SCA SPBC Mobile BusAdd Remove Add Remove
Outlook and District Health Centre
Grenfell Health CentreLong Lake Integrated Facility - Imperial
Montmartre Health CentreWhitewood Community Health Centre
Saskatchewan Hospital - North Battleford
Approval Section
Radiologists to allow proxy for: (attach list if needed)
RIS Proxy Information
I acknowledge that the User is permitted access to the selected services. If PACS is selected, I acknowledge that the User has read the PACS Joint Services / Access Policy and understands their responsibilities and the appropriate use of PACS as described in the Joint Services / Access Policy as well as their obligations under HIPA. I further acknowledge that I understand my obligations under HIPA.
NOTE: All SHA requests must be sent from the Approver's SHA email account to [email protected].
The most recent version of this form can be downloaded at: http://www.ehealthsask.ca/forms
May 2018 - Page 3 of 3
Add RemoveSun Country
Arcola Health CentreGalloway Health Centre - Oxbow
Redvers Health CentreKipling Integrated Health Centre
Add RemoveWeyburn General Hospital
Radville Marion Health Centre
SunriseAdd Remove
Canora HospitalKamsack Hospital & Nursing Home
St. Anthony's Hospital - Esterhazy
Add RemoveYorkton Regional Health CentreSt. Peter's Hospital - Melville
St. Joseph's Hospital - Estevan
Private Practice Only: PACS Users MUST SIGN this Joint Services / Access Policy ConfirmationI acknowledge I have access to the following. (Please confirm by placing a checkmark in the appropriate boxes):
I acknowledge that I understand that I am legally bound by, and agree to comply with, the PACS Joint Services/Access Policy.
Name (print):
Signature:
Radiologists to allow proxy by: (attach list if needed)
Preparing Your Medical Practice for HIPA and PIPEDA. PACS Joint Services / Access Policy.
Remote Radiologist (does not use eHS PS360)ResidentRadiologist
AVAILABLE AT: https://www.ehealthsask.ca/services/PACS/Pages/Register-Pacs-Account.aspx
