Funeral Home Enrollment Slides - backyard

VIP ACCOUNT ENROLLMENT ELECTRONIC DEATH REGISTRATION SYSTEM (EDRS) FUNERAL HOMES EDITION Massachuse(s Dept. of Public Health Registry of Vital Records and Sta=s=cs WEBINAR -­‐ VIDEO VERSION There are four forms to fill out •  Three on paper to be mailed to RVRS: 1. Virtual Gateway (VG) Services Agreement 2. Designa=on of Access Administrator Agreement 3. VIP User Agreement Registry of Vital Records and Sta=s=cs ATTN: Hansy Noel 150 Mt. Vernon Street, 1st Floor Boston, MA 02125-­‐3105 •  One form to be filled out in Excel and emailed to RVRS 4. User Request Form VIPProjectTeam@state.ma.us VG Services Agreement •  One per organiza=on •  Submit the paper original Virtual Gateway Service terms Contract between your organiza=on and the Commonwealth. Designa=on of Access Administrator Agreement Iden=fy your Access Administrator Access Administrator manages all of your users Document to be signed by your owner or director •  One per organiza=on •  Submit the paper originals by USPS VIP User Agreement •  One per or Administrator •  Submit the paper original RSVS user agreement terms and condi=ons. Every person is required to read and sign. USER REQUEST FORM Access Administrator emails the User Request to VIPProjectTeam@massmail.state.ma.us Required to generate the VIP and VG user accounts. Form is used for future user changes. •  One per organiza=on •  Email the Excel file from the ACCESS ADMINISTRATOR Overview of Steps 1 • Virtual Gateway (VG) Services Agreement 2 • Designa=on of Access Administrator Agreement 3 • Vitals Informa=on Partnership (VIP) User Agreement 4 •  User Request Form (to be sent electronically) 1 Virtual Gateway (VG) Services Agreement VG Services Agreement (Completed Sample) 1 2 •  Enter Name of Authorized Representa=ve •  Enter Name of Organiza=on Represented •  Enter Address of Organiza=on •  Enter the name of the Organiza=on •  Enter the FEIN or Tax ID # •  Authorized signature of Representa=ve •  Printed Name of Representa=ve •  Date signed •  Leave the Commonwealth por=on blank 2 Designa=on of Access Administrator Agreement Designa=on Access Administrator Agreement 1 2 (Completed Page 1 of 2) • User: Enter the organizaFon name it is the name on the VG Services Agreement • Enter the FEIN # or the TAX ID of the organizaFon 3 • The authorized signatory of the organizaFon signs and then prints name, Ftle and dates the form 4 • The person who will be designated ACCESS ADMINISTRATOR signs, then prints name and Ftle Designa=on Access Administrator Agreement (Completed Page 2 of 2) 1 • An Authorized Signatory chooses to either DESIGNATE or REMOVE an ACCESS ADMINISTRATOR & provides contact info 2 • Enter the name of the organizaFon 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 secFon should be completed to provide a backup ACCESS ADMINISTRATOR in the event the main person is unavailable and during Fmes of transiFon. Complete the same as above 4 • The authorized signatory of the enFty signs granFng above named person(s) Access AdministraFon privileges' Designa=on Access Administrator Agreement (Removal of Administrator) Select the remove op=on The signatory of the organiza=on fills this sec=on in This is the informa=on for the person you wish to REMOVE as access administrator Authorized Signatory Signs, Prints and Dates the Form David Chapman Chapman Cole & Gleason Funeral Home 781-­‐999-­‐9999 6-­‐29-­‐2013 Chapman, Cole & Gleason Funeral Home 2599 Cranberry Highway Wareham, MA 02521 Christopher W. Berg Chrisberg@ccgfuneralhome.com 508-­‐999-­‐9999 508-­‐999-­‐9991 0060
5082 David Chapman David Chapman 6 29 12 3 VIP – User Agreement VIP – User Agreement • User reads terms and condi=ons of agreement 1 2 (Completed Page 1 of 2) • Enter the Users’ Name • Employer • Title • Contact Number • Contact Email RVRS – User Agreement 1 2 3 (Completed Page 2 of 2) • Choose the appropriate access being requested for User • User reads all 10 agreements • User Signs and Dates Form 4 Vital Informa=on 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:
VIPProjecteam@massmail.state.ma.us
PLEASE SUBMIT ONE FORM PER EMAIL
Questions? Call the EOHHS Virtual Gateway Customer Service
PHONE 800-421-0938
TTY
617-847-6578
Commonwealth of Massachusetts
Executive Office of Health and Human Services
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:
New User Request & Account Modification
Form for Virtual Gateway Access
(TYPE INFORMATION DIRECTLY INTO FORM)
vipprojectteam@massmail.state.ma.us
Vitals Information Processing (VIP)
User Request Form (URF)
PLEASE SUBMIT ONE FORM PER EMAIL
Questions? Call the EOHHS Virtual Gateway Customer Service
PHONE 800-421-0938
TTY
617-847-6578
VG Role Name: VIP USER
Birthing
Facility
Users
City or
Town Users
Funeral Home Users
Board of
Health
Users
Medical Certifier
Users
Medical Examiner
Users
Registry of Vital Records and Statistics (RVRS) Users
* 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.
**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.
Access Administrator
Name
Organization
Full Name
Access Administrator
Email Address
Organization ID
Number
Access Administrator
Telephone
Date
Deactivate Existing User from
the Virtual Gateway
Deactivate Existing User
from VIP
Modify Existing User
New User
RVRS Administration
RVRS Amendments
RVRS Registration
RVRS Statistical Group
RVRS Customer Service Group
(used for Issuance)
Medical Examiner Group
Medical Examiner Data Entry Group
Medical Certifier Group
Work Phone #
Medical Data Entry Group
Work
E-mail Address
Burial Agent Group
MMDD of Birth
Funeral Home Director Group
4-Digit PIN*
(Personal
Identification
Number)
Funeral Home Assistant Group
Last Name
City/Town Clerk Group**
MI
City/Town Customer ServiceGroup
(used for Issuance)
First Name
Birth Hospital Group
Check One
User Request Form We will break this down into three parts as this will be completed and submi(ed electronically as an excel file User Request Form •  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-­‐fi_h = 0525) •  Enter User(s) Work Email •  Enter User(s) Work Phone # Christopher W Berg 8955 0525 chrisberg@ccgfuneral.com 508-­‐999-­‐9999 User Request Form Select from the list the proper group for the user(s) In this example we are selec=ng a funeral home data entry X Select op=on to add or modify user(s) account X User Request Form David Chapman Chapman Cole & Gleason dchapman@ccgassoc.com 12345-­‐67 781-­‐999-­‐9999 8-­‐13-­‐2013 The Access Administrator Instruc=ons:
1. All non-­‐role fields are required.
finishes the User Request 2. Fill in form, put an "X" in the column with the requested ac=on.
Form (URF) 3. Save document as YourOrganiza=onName_MMDDYY.
& 4. Email completed form to:
Save document as described VIPProjec(eam@massmail.state.ma.us
& Send the document to PLEASE SUBMIT ONE FORM PER EMAIL
VIP Project team email Ques=ons? Call the EOHHS Virtual Gateway Customer Service
PHONE 800-­‐421-­‐0938
TTY
617-­‐847-­‐6578
Checklist before submission •  VG Services Agreement –  Required for each organiza=on accessing VIP and/
or the EDRS •  Designa=on 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 condi=ons 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 MAIL FORMS TO: Registry of Vital Records and Sta=s=cs ATTN: Hansy Noel 150 Mt. Vernon Street, 1st Floor Boston, MA 02125-­‐3105 EMAIL TO: VIPProjectTeam@state.ma.us THANKS! WE LOOK FORWARD TO JANUARY 1 AND OUR NEW ELECTRONIC DEATH REGISTRATION SYSTEM THE VITALS TEAM ST
QUESTIONS? VIPProjectTeam@massmail.state.ma.us Quick Reference Guide VIP Enrollment FORMS Funeral Homes Registry of Vital Records and Sta=s=cs IGNORE ALL OTHER ADDRESSESS ATTN: Hansy Noel * USE ONLY THIS ADDRESS * 150 Mt. Vernon Street, 1st Floor Boston, MA 02125-­‐3105 VIPProjectTeam@state.ma.us 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 * DesignaFon of Access Administrator – Manages user access, addi=on & 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