vip account enrollment electronic death registration system (edrs) funeral homes edition
DESCRIPTION
VIP Account Enrollment Electronic Death Registration System (EDRS) Funeral Homes Edition. Massachusetts Dept. of Public Health Registry of Vital Records and Statistics WEBINAR - VIDEO VERSION. There are four forms to fill out. Three on paper to be mailed to RVRS: - PowerPoint PPT PresentationTRANSCRIPT
VIP ACCOUNT ENROLLMENTELECTRONIC DEATH REGISTRATION SYSTEM (EDRS)
FUNERAL HOMES EDITION
Massachusetts Dept. of Public Health Registry of Vital Records and Statistics
WEBINAR - VIDEO VERSION
There are four forms to fill out• Three on paper to be mailed to RVRS:
1. Virtual Gateway (VG) Services Agreement2. Designation of Access Administrator Agreement 3. VIP User Agreement
Registry of Vital Records and StatisticsATTN: Hansy Noel
150 Mt. Vernon Street, 1st FloorBoston, MA 02125-3105
• One form to be filled out in Excel and emailed to RVRS4. User Request Form
VG Services Agreement
Virtual Gateway Service terms
Contract between your organization and the Commonwealth.
• One per organization
• Submit the paper original
Designation of AccessAdministrator AgreementIdentify your Access Administrator
Access Administrator manages all of your users
Document to be signed by your owner or director
• One per organization• Submit the paper originals by USPS
VIP User Agreement
RSVS user agreement terms and conditions.
Every person is required to read and sign.
• One per or Administrator• Submit the paper original
USER REQUEST FORM
• One per organization• Email the Excel file from the
ACCESS ADMINISTRATOR
Access Administrator emails the User Request to [email protected]
Required to generate the VIP and VG user accounts.
Form is used for future user changes.
• Virtual Gateway (VG) Services Agreement1
• Designation of Access Administrator Agreement2
• Vitals Information Partnership (VIP) User Agreement3
• User Request Form (to be sent electronically)4
Overview of Steps
1Virtual Gateway (VG) Services Agreement
VG Services Agreement(Completed Sample)
1• Enter Name of Authorized Representative• Enter Name of Organization Represented• Enter Address of Organization
2• Enter the name of the Organization• Enter the FEIN or Tax ID #• Authorized signature of Representative• Printed Name of Representative• Date signed• Leave the Commonwealth portion blank
1
2
2Designation of Access
Administrator Agreement
Designation AccessAdministrator Agreement
(Completed Page 1 of 2)
1• User: Enter the organization name it is the name
on the VG Services Agreement
2• Enter the FEIN # or the TAX ID of the
organization
3
• The authorized signatory of the organization signs and then prints name, title and dates the form
4
• The person who will be designated ACCESS ADMINISTRATOR signs, then prints name and title
123
4
(Completed Page 2 of 2)
Designation AccessAdministrator Agreement
1• An Authorized Signatory chooses to either DESIGNATE or
REMOVE an ACCESS ADMINISTRATOR & provides contact info
2
• Enter the name of the organization followed by its address and finally the name of the access administrator. Two 4-Digit pins must be made up and cannot include (1234, 0000)
3
• This section should be completed to provide a backup ACCESS ADMINISTRATOR in the event the main person is unavailable and during times of transition. Complete the same as above
4
• The authorized signatory of the entity signs granting above named person(s) Access Administration privileges'
1
234
David ChapmanChapman Cole & Gleason Funeral Home781-999-9999 6-29-2013
Chapman, Cole & Gleason Funeral Home2599 Cranberry Highway
Wareham, MA 02521Christopher W. Berg
[email protected] 508-999-9991
0060 5082
David Chapman David Chapman 6 29 12
Designation AccessAdministrator Agreement(Removal of Administrator)
Select the remove option
The signatory of the organization fills this section in
This is the information for the person you wish to REMOVE as access administrator
Authorized Signatory Signs, Prints and Dates the Form
3VIP – User Agreement
(Completed Page 1 of 2)
VIP – User Agreement
1• User reads terms and conditions of agreement
2
• Enter the Users’ Name• Employer• Title• Contact Number• Contact Email
2
1
RVRS – User Agreement
(Completed Page 2 of 2)
1• Choose the appropriate access
being requested for User
2• User reads all 10 agreements
3• User Signs and Dates Form
1
2
3
4Vital Information Partnership (VIP)
User Request Form (URF)
Instructions:1. All non-role fields are required.2. Fill in form, put an "X" in the column with the requested action.3. Save document as YourOrganizationName_MMDDYY.4. Email completed form to:
PLEASE SUBMIT ONE FORM PER EMAIL
Questions? Call the EOHHS Virtual Gateway Customer ServicePHONE 800-421-0938TTY 617-847-6578
BirthingFacilityUsers
Board of Health Users
First Name MI Last Name
4-Digit PIN* (Personal
Identification Number) MMDD of Birth
Work E-mail Address Work Phone # B
irth
Hos
pita
l Gro
up
City
/Tow
n C
usto
mer
Ser
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up(u
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nce)
City
/Tow
n C
lerk
Gro
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Fune
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ome
Ass
ista
nt G
roup
Fune
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ome
Dire
ctor
Gro
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Bur
ial A
gent
Gro
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Med
ical
Dat
a En
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Med
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Cer
tifie
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Med
ical
Exa
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ata
Ent
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roup
Med
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Exa
min
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RVR
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usto
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ssua
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RVR
S St
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RVR
S R
egis
trat
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RVR
S A
men
dmen
ts
RVR
S A
dmin
istr
atio
n
New
Use
r
Mod
ify E
xist
ing
Use
r
Dea
ctiv
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Exis
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IP
Dea
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atew
ay
Commonwealth of MassachusettsExecutive Office of Health and Human Services
New User Request & Account Modification Form for Virtual Gateway Access
* Select a 4 digit Personal Identification Number (PIN). The user may be asked to provide this number to identify himself/herself when calling Virtual Gateway Customer Service. It must be 4 numbers (0-9) and be something that can be remembered, but not easily guessed. 1234 and 0000 may not be used.
Check One
(TYPE INFORMATION DIRECTLY INTO FORM)
VG Role Name: VIP USER
City or Town Users
Funeral Home Users Medical Certifier Users
Access Administrator Email Address
Organization Full Name
Organization ID Number
Date
Vitals Information Processing (VIP)User Request Form (URF)
**If a user has City/Town Clerk Group privileges they will have Customer Service Group privileges by default
I HEREBY CERTIFY THAT I AM THE DULY AUTHORIZED ACCESS ADMINISTRATOR FOR MY ORGANIZATION OR AGENCY, AND THAT ALL OF THE INFORMATION I AM PROVIDING TO VIRTUAL GATEWAY OPERATIONS IS ACCURATE AND COMPLETE.
Medical Examiner Users Registry of Vital Records and Statistics (RVRS) Users
Access Administrator Telephone
Access Administrator Name
Instructions:1. All non-role fields are required.2. Fill in form, put an "X" in the column with the requested action.3. Save document as YourOrganizationName_MMDDYY.4. Email completed form to:
PLEASE SUBMIT ONE FORM PER EMAIL
Questions? Call the EOHHS Virtual Gateway Customer ServicePHONE 800-421-0938TTY 617-847-6578
User Request Form
We will break this down into three parts as this will be completed and submitted electronically as an excel file
1 2
3
1
Christopher W Berg 8955 [email protected]
508-999-9999
• Enter the name(s) of each user• Enter 4 digit pin for user
• (pin CANNOT be 0000 or 1234)
• Enter User(s) Month and Day of Birth
• (e.g. May Twenty-fifth = 0525)
• Enter User(s) Work Email• Enter User(s) Work Phone #
User Request Form
2
X X
Select from the list the proper group for the user(s)In this example we are selecting a funeral home data entry
Select option to add or modify user(s) account
User Request Form
Instructions:1. All non-role fields are required.2. Fill in form, put an "X" in the column with the requested action.3. Save document as YourOrganizationName_MMDDYY.4. Email completed form to:
PLEASE SUBMIT ONE FORM PER EMAIL
Questions? Call the EOHHS Virtual Gateway Customer ServicePHONE 800-421-0938TTY 617-847-6578
3David Chapman
781-999-9999
Chapman Cole & Gleason
12345-67
8-13-2013
The Access Administrator finishes the User Request
Form (URF)&
Save document as described&
Send the document to VIP Project team email
User Request Form
• VG Services Agreement– Required for each organization accessing VIP and/or the
EDRS• Designation of Access Administrator
– Required to establish and maintain access to the VIP and/or EDRS
– A backup should be administrator is strongly recommended • VIP User Agreement
– Each individual person who will be accessing the VIP and/or EDRS is required to agree to the terms and conditions of the VIP system.
– SHARING ACCOUNTS IS NOT ALLOWED• User Request Form
– To be emailed by the Access Administrator from the email account on file with the Virtual Gateway
Checklist before submission
MAIL FORMS TO:
Registry of Vital Records and StatisticsATTN: Hansy Noel
150 Mt. Vernon Street, 1st FloorBoston, MA 02125-3105
EMAIL TO:[email protected]
THANKS!
WE LOOK FORWARD TO JANUARY 1ST
AND OUR NEW ELECTRONIC DEATH REGISTRATION SYSTEM
THE VITALS TEAM
Quick Reference GuideVIP Enrollment FORMS
Funeral Homes
Registry of Vital Records and Statistics IGNORE ALL OTHER ADDRESSESSATTN: Hansy Noel * USE ONLY THIS ADDRESS * 150 Mt. Vernon Street, 1st FloorBoston, MA 02125-3105
BY PAPER ( * 3 weeks to process the set * )
VG Services Agreement – Contract between you and our MA IT Services* need your Tax Id # and level III or VI director to sign *
Designation of Access Administrator – Manages user access, addition & removal* designate one, with one or more backup admins *
VIP User Agreement – Every user promises to follow policies* every user acknowledges on paper *
BY EMAIL ( * 2 days to process * )
User Request Form – Access Admin manages users by excel & email