BRONSON HEALTHCARE GROUP
PYXIS MedStation User ID Request
FACILITY SITE Check the site in which the employee will have permanent access.
[ ] BBC/Fieldstone
[ ] BLH
[ ] BMH
[ ] OTHER_____________
ID Expiration Date: ___/___/___
Pyxis User ID: | __ | __ | __ | __ | __ | __ | _ _ | _ _ |
(Required for Student, Instructor, limited time access)
(Employee ID # or Network ID)
First Name:
| __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ |
Last Name:
| __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ | __ |
User Type: Check the user role for each for which the employee will have permanent access.
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Anesthesiologist
Charge Nurse
Contractor (Non Perm)
CRNA
CVL/Rad Tech
EMT
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LVN (Lic.Voc.Nurse)
Graduate Nurse
MD
Nurse Extern
Paramedic
PCA/Medical Asst.
Pharmacist
LPN
Permanent Access Location:
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Pharmacy
Administration
Pharmacy Manager
Pharm Tech
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ADUL (Fieldstone
Adult)
AGER (Fieldstone
Geriatric)
ANEST_ASC (OR
Anesthesia Trays )
BBCER (Emergency
Room)
BBCER2(Emergency
Room)
BC4 (Birth Center)
CC13 (Critical Care)
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Respiratory Therapist
Student Nurse
Supply Tech
Surgical Tech
PA (Physician Asst.)
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RN
________ Other
RN Hosp. Super (BLH)
Resident
Check the location for each system in which the employee will have permanent access.
BBC-SITE: SEND COMPLETED FORMS TO: BBC INPATIENT PHARMACY DEPT.
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CC23 (Critical Care)
CHEMO (Outpatient
Chemo)
CP3A (Cardiac A)
CP3B (Cardiac B)
CP3C (Cardiac C)
CVL (Cardiovascular
Lab)
EMS (Paramedics)
ENDO_ASC
(Endoscopy)
HOLDRM (PACU)
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MEDRM_ASC (PrePost Surgery)
MO5A (Oncology A)
M05B (Oncology B)
M05C (Oncology C)
ON2A
(Neurovascular/Ortho
A)
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OR_INPAT(OR
Inpatient)
PACU_ASC (OR
Inpatient)
PD4 (Pediatrics)
SPECIALS (Specials)
SS4 (Short
Stay/Overflow)
ON2B
(Neurovascular/Ortho
B)
ON2C
(Neurovascular/Ortho
C)
BLH SITE: SEND COMPLETED FORMS TO: BLH INPATIENT PHARMACY @ BOX 90
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BLH-ACU (Adult Care Unit)
[ ] BLH-BH (Behavioral Health Unit)
[ ] BLH-ED
[ ] BLH-OR/RR
[ ] BLH-IMAGING
BMH-SITE: SEND COMPLETED FORMS TO: BMH PYXIS COORDINATOR-- BOX 56 OR TUBE STATION #200
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ALLO (Allograft)
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AMU (Adult Medical
Unit)
APU (ANTEPARTUM)
AU (ADMISSION
UNIT)
BOS (Outpatient
Surgery)
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BOSC (Outpt Surg
Center)
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BSS (Bronson
Staffing)
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BUR (Burn Clinic)
CAR
(Cardiac/Telemetry)
CATH (Cath Lab)
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CCU (MICU)
CSU/PACU (Cardiac
Surgical & Inpatient
Recovery)
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ED (Emergency Room
& Clinical Decision
Unit)
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EMCU (EXTENDED
MEDICAL CARE)
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ENDO (Endoscopy)
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GMU (General
Medical)
GSU (General
Surgical)
INFUSION
IPRAD (Inpatient Rad)
MRI
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NCCU (Neurovascular
Critical Care)
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NICU (Neonatal ICU)
NVU (Neurovascular
Unit)
OBD (Labor &
Delivery)
OBF (Mother/Baby
Unit)
OBR (Recovery)
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PICU (Pediatric ICU)
PRU (PREP &
RECOVERY)
SPO (Surgical Pre-Op)
SUR (Surgery)
TCU (Trauma Care
Unit)
VER (Vicksburg ER)
VIP (Volume Influx
Pool)
OPRAD (OutpatientRad)
OSU (Ortho Surgical)
PED (Pediatrics)
PED-HEMONC (Ped
Hematology/Oncology)
(OVER)
I, the undersigned, acknowledge receipt of my Pyxis MedStation User ID Code. I further agree and understand that:
1.
2.
3.
4.
5.
6.
I will change my initial User ID code to a code of my
choice upon receipt of the initial password code;
I understand that no retrievable record of my new
Password exists;
I will not disclose my code to anyone;
My User ID code and Password is the equivalent of my
legal signature and it will be used to track all of my
transactions on the system;
I understand that the use of another person’s computer
User ID Code or Password, or delegation of my code to
another person, would likely be considered False
Representation;
If I have reason to believe that the confidentiality of my
User ID code has been broken, I will immediately change
my password code;
7.
8.
9.
10.
I agree to accurately input data into the MedStation of all
medications withdrawn, loaded, refilled and inventoried by
me; including the correct quantity of the medication;
I agree to immediately report any discrepancies to my
Charge Nurse and/or Nurse Manager;
I agree to identify and report any malfunctions of the
Pyxis MedStation;
I am advised that failure to comply with these policies and
regulations may result in disciplinary action, which could
include release from employment. Violation of local,
State of Michigan, or United States Federal statutes may
carry the additional consequence of prosecution under
the law, where judicial action may result in specified fines
or imprisonment, or both; plus the costs of litigation or the
payment of damages, or both; or all.
These records will be maintained and archived as per the policies of this hospital and will be available for inspection by the Drug Enforcement Agency (DEA) and the State Board of Pharmacy, as is presently
done with my handwritten signature for controlled substance records. I also understand that to maintain the integrity of my electronic signature, I must not give this password to any other individual.
I have read and understood the above requirements and willingly agree to abide by them during my employment/association at Bronson Hospital. A copy of this document will be kept on file in the Pharmacy.
Signature of Pyxis User
Date
Name of person to notify when in system:
Signature of Manager/Supervisor/Nurse
Educator
Date
Pharmacy Use Only:
Processed By:
Signature of Pharmacy Designee
(Revised: 10/26/15)
Date
Date: