VitalCore – New User Setup VitalCore – New User Setup Requestor Name: * Requestor Name: First First Last Last Requestor Email: * New Employee Name: * New Employee Name: First First Last Last Start Date: * Urgency Of Email Creation: * Select Immediately 10 Hours Or Less 24 Hours No Urgency Office: {Site (Primary Location)}: * Select 7000 – Corporate Office 7001 – VitalCore Corporate 7010 – JoCo Adult Residential Center 7011 – JoCo Juvenile 7012 – JoCo Central Booking 7013 – JoCo New Century 7014 – Sedgwick Co. Adult Detention Center 7015 – Sedgwick Co. Jail Annex 7016 – Sedgwick Co. Juv Detention Facility 7017 – Sedgwick Co. Juv Residential Facility 7101 – Grant County NM 7104 – Otero County NM 7201 – Jefferson County MO 7202 – St. Charles County DOC 7301 – Stark County OH 7302 – Stark County Behavioral Health, OH 7303 – Warren County OH 7401 – Ottawa County MI Jail 7403 – Saginaw MI 7404 – Kent Co Correctional Facility 7405 – Kent Co Juvenile 7406 – Muskegon County Jail 7450 – Florida Regional Office 7501 – Jackson County MS 7502 – Madison County MS – Adult 7503 – Rankin County Adult 7504 – Rankin County Juvenile 7506 – Harrison County MS – Adult 7508 – Central MS Correctional Facility 7509 – East MS Correctional Facility 7510 – Marshall County Correctional Facility 7511 – MS State Penitentiary 7512 – South MS Correctional Institute 7513 – Wilkinson County Correctional Facility 7514 – Walnut Grove Correctional Facility 7520 – MS Regional Office 7550 – Galveston County 7601 – Chesapeake VA Juvenile 7602 – VA – Regional Office 7603 – VA – Augusta Correctional Center 7604 – VA – Coffeewood Correctional Center 7605 – VA – Deerfield Correctional Center 7607 – VA – Greensville Correctional Center 7608 – VA – Greensville Work Center 7609 – VA – Indian Creek Correctional Center 7610 – VA – Lunenburg Correctional Center 7611 – VA – St. Brides Correctional Center 7612 – VA – State Farm Enterprise 7613 – VA – State Farm Infirmary 7650 – VT – Northeast Region (VT Regional Office) 7651 – VT- CRCF & 7655 – NWSCF 7651 – VT – CRCF 7652 – VT – MVRCF 7653 – VT – NECC 7654 – VT – NSCF 7655 – VT – NWSCF 7656 – VT – SSCF 7750 – Outagamie County Jail, WI 7801 – Canyon County ID 7803 – Kootenai County, ID 7850 – Weber County UT 7902 – Jefferson County Detention Center Is This User An MSDOC: * Select Yes No Supervisor: * Mobile Phone: Office Phone: * Fax Number: Subscription Office 365 Subscription: * Select E5 (Office + Email + Intune + Compliance) – $57/mo Frontline – Nurses, Admin Assistants, etc. (Office 365 F3, EOP2, AIP, O365 ATP P1) – $16 Email: * Department: * Select Business Development Corporate – Guest Corporate Corporate – Accounting Corporate – Business Development Corporate – Consultant Corporate – Marketing Corporate – UM Corporate – Staff Corporate – Finance Human Resources Investment IT IT – WOMOSL Legal Marketing Need Department Need Location Partner Regional Administrative Staff – MSRO Regional Administrative Staff – VA Regional Office Regional Administrative Staff – VT – CRCF Regional Administrative Staff – VT – Northeast Region Regional IT Staff – MSRO Regional MAT Staff – VT – Northeast Region Regional Medical Staff – MSRO Regional Medical Staff – VT – Northeast Region Site Dental Staff – CMCF Site Dental Staff – Galveston County Site Dental Staff – MCCF Site Dental Staff – MSP Site Dental Staff – Outagamie County Site Dental Staff – SMCI Site Dental Staff – WCCF Site Admin Staff – CMCF Site Admin Staff – EMCF Site Admin Staff – Galveston County Site Admin Staff – KCCF Site Admin Staff – MCCF Site Admin Staff – MSP Site Admin Staff – MSRO Site Admin Staff – Outagamie County Site Admin Staff – SMCI Site Admin Staff – Sedgwick County Site Admin Staff – St. Charles County DOC Site Admin Staff – WCCF Site Admin Staff – WGCF Site Administrative Staff – Chesapeake VA Site Administrative Staff – Florida Regional Office Site Administrative Staff – Grant County NM Site Administrative Staff – Harrison County MI Site Administrative Staff – Hidalgo County NM Site Administrative Staff – Jackson County MS Site Administrative Staff – Jefferson County MO Site Administrative Staff – Jefferson MO Site Administrative Staff – Jefferson County Detention Center Site Administrative Staff – JoCo – CB Site Administrative Staff – JoCo – NC Site Administrative Staff – Kootenai County ID Site Administrative Staff – Muskegon County Jail Site Administrative Staff – Muskegon County Juvenile Site Administrative Staff – Otero County NM Site Administrative Staff – Ottawa County MI Site Administrative Staff – Rio Arriba NM Site Administrative Staff – Saginaw Site Administrative Staff – Stark County OH Site Administrative Staff – Weber County UT Site Administrative Staff – Canyon County ID Site Administrative Staff – VT – CRCF Site Administrative Staff – VT – MVRCF Site Administrative Staff – VT – NECC Site Administrative Staff – VT – Northeast Region Site Administrative Staff – VT – NSCF Site Administrative Staff – VT – NWSCF Site Administrative Staff – VT – SSCF Site Administrative Staff – Otero County NM Site Administrative Staff – Ottawa County MI Jail Site Administrative Staff – Warren County OH Site Behavioral Health Staff – VT – CRCF Site Behavioral Health Staff – VT – MVRCF Site Behavioral Health Staff – VT – NECC Site Behavioral Health Staff – VT – NSCF Site Behavioral Health Staff – VT – NWSCF Site Behavioral Health Staff – VT – SSCF Site Dental Staff – EMCF Site Dental Staff – KCCF Site Dental Staff – MSRO Site General Account – Grant County NM Site General Account – Hidalgo County NM Site General Account – Madison MS Site General Account – Rankin MS – Adult Site MAT Staff – VT – CRCF Site MAT Staff – VT – NECC Site MAT Staff – VT – NSCF Site MAT Staff – VT – SSCF Site Medical Staff – Canyon County ID Site Medical Staff – CMCF Site Medical Staff – EMCF Site Medical Staff – Florida Regional Office Site Medical Staff – Galveston County Site Medical Staff – Grant County NM Site Medical Staff – Harrison County MS Site Medical Staff – Harrison County MS – Adult Site Medical Staff – Hidalgo County NM Site Medical Staff – Jackson County MS Site Medical Staff – Jackson MS Site Medical Staff -Jefferson County MO Site Medical Staff – Jefferson MO Site Medical Staff – Jefferson County Detention Center Site Medical Staff – JoCo – ARC Site Medical Staff – JoCo – CB Site Medical Staff – JoCo – Juvenile Site Medical Staff – JoCo – Juvenile – ARC Site Medical Staff – JoCo – NC Site Medical Staff – JoCo – Need Location Site Medical Staff – KCCF Site Medical Staff – Kootenai County ID Site Medical Staff – Madison County MS Site Medical Staff – Madison MS Site Medical Staff – MCCF Site Medical Staff – MSP Site Medical Staff – MSRO Site Medical Staff – Muskegon County Jail Site Medical Staff – Muskegon County Juvenile Site Medical Staff – Otero County NM Site Medical Staff – Ottawa County MI Jail Site Medical Staff – Outagamie County Site Medical Staff – Rankin County MS Site Medical Staff – Rankin MI – Juvenile Site Medical Staff – Rio Arriba County NM Site Medical Staff – Rio Arriba NM Site Medical Staff – Saginaw Site Medical Staff – Sedgwick County Site Medical Staff – SMCI Site Medical Staff – Stark County OH Site Medical Staff – St. Charles County DOC Site Medical Staff – VT – CRCF Site Medical Staff – VT – CRCF *Agency – TLC Agency Staff Site Medical Staff – VT – MVRCF Site Medical Staff – VT – MVRCF *Agency – Supplemental Site Medical Staff – VT – NECC Site Medical Staff – VT – NECC *Agency – Supplemental Agency Site Medical Staff – VT – NSCF Site Medical Staff – VT – NWSCF Site Medical Staff – VT – NWSCF *Agency – TLC Agency Staff Site Medical Staff – VT – SSCF Site Medical Staff – VT – SSCF *Agency – Cell Staff Agency Site Medical Staff – VT – SSCF *Agency – Platinum Site Medical Staff – VT – SSCF *Agency – TLC Agency Staff Site Medical Staff – WGCF Site Medical Staff – Warren County OH Site Medical Staff – WCCF Site Medical Staff – Weber County UT Site Medical Staff – Saginaw Stark County Stie Medical Staff – JoCo – CB Terminated Vermont DOC Title: * Select Accounts Manager Administrative Assistant Administrative Consultant Administrative Officer Administrator ADON Agency – X-Ray Tech AHSA APRN: Advanced Practice Registered Nurse Assistant Director of Health Services Assistant HSA Behavioral Health Behavioral Health – Masters Behavioral Health Administrative Assistant Behavioral Health APRN Behavioral Health Coordinator Behavioral Health Direct/Psych Behavioral Health Professional Behavioral Health Specialist BHC: Behavioral Health Coordinator Business Development CEMT Central Supply Manager CEO Chairman of the Board Charge Nurse Charge RN Chief Accounting Officer Chief Financial Officer Chief Legal Council Chief of Operation Chief of Staff Chief Operating Officer – Clinical Services Chief Psychiatrist Clinic/MH Admin. Assitant Clinical Director CMA Compliance Monitor Consultant Contract Doctor DA: Dental Assistant DDS: Doctor of Dental Surgery DDS-PT Dental Assistant Dental Director Dentist Director of Dental Services Director of Information Technology Director of Marketing – Acting DO Director of Mental Health Services Director of Nursing Director of Nursing/Site Mgr Director of Operations Director of Quality Improvement Discharge Planner DO: Director of Operations DO: Director of Operations – RN-PRN Doctor DON: Director of Nursing DON: Director of Nursing – Acting HSA EHR Manager EMT/Paramedic Facility Administrator Family Nurse Practitioner File Clerk FNP General Account Health Services Administrator Health Services Coordinator – HSC HIPAA Expert Hospital Utilization Human Resources Human Resources – System Admin I.T. Manager Infection Control Coord RN Interim HSA Investor Lab Supervisor Lab Technician LCSW Legal Consultant LMSW LNA: Licensed Nursing Assistant LNA: Licensed Nursing Assistant – Medical Records Clerk LPN: Licensed Practical Nurse LPN: Nurse Practitioner LPN – FT LPN – PRN LVN M.H. Marketing Coordinator MAT Case Manager MD MD – General MD/Director of Mental Health Training MD/DO/General Family Med/Emergency Med Cart Med Tech Medical Assistant Medical Clerk Medical Director Medical Director – Doctor Medical Provider Medical Records Clerk Medical Records Supervisor Medical Records/HIT Medical Supervisor Medical Supply Assistant Medication Assisted Treatment Case Manager Mental Health Coordinator Mental Health Counselor Mental Health Director Mental Health Therapist Mental Health Worker MH – APRN Midlevel MH Coordinator MH Counselor MHP MHP – PRN Mid Level PA – Advanced Practice Practitioner Need Job Profile Nurse Nurse – LPN Nurse – RN Nurse Manager Nurse Practitioner Nursing Assitant Office Manager On-Site Coordinator Optometrist PA Pharmacist Pharmacy Director Pharmacy Tech Phlebotomist Phlebotomy Technician Physical Therapist Physician President of Business Development President of Clinical Affairs – Behavioral Health PRN – Marketing PRN RN Provider Psych APRN Psychiatric Mental Health Nurse Psychiatrist PT: Physical Therapist QBHP: Qualified Behavioral Health Professional Records Clerk Regional Business Analyst of Quality Improvement Regional Director of Behavioral Health Regional Director of Nursing Regional Director of Psychiatry Regional Director of Quality Improvement Regional Medical Director Regional Medication Assisted Treatment Care Behavioral Health Regional Medication Assisted Treatment Care Coordinator Regional Medication Assisted Treatment Medical Director Regional Office Manager Regional Physician Regional Utilization Management Supervisor RN – Mental Health RN – PRN – Nurse RN (Night) RN: Registered Nurse RN: Registered Nurse – Acting HSA RN MSN RN Supervisor RN/Director of Operations RN/Mental Health Scheduler Secretary Admin Asst Secretary Admin Asst BH Site Medical Director Specialist Specialty Care Coordinator Statewide Director of Nursing Statewide Medical Director Systems Administrator Technology Consultant Telepsych Utilization Management Liaison Vice President of Human Resources Vice President of Operations Vice President of Operations – West Vice President of Utilization Management VP of Medical Services – Facility Administrator VP of Operations VP of Operations – Mississippi Region VP of Quality Management Position: * Select Administrative Assistant Deputy Doctor EMT Facility Administrator Head Nurse Health Services Administrator Medical Records Mental Health Nurse Nurse Practitioner PA Secretary System Administrator Other Position: Additional Notes/Requests/Notes of anything not covered above: If you are human, leave this field blank. 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