Integrated Assessment Record (IAR)
HEALTH SERVICE PROVIDER AND USER ACCESS REQUEST FORM
Purpose of this Form:
 Change Health Service Provider (HSP) contact information
 Add, change and/or remove user accounts and permissions
 Add and/or remove static Internet Protocol (IP) address
 Manage password resets and reactivations
Before submitting this form for the first time, ensure an IAR Business Sustainment Roles Request Form has been submitted and up-to-date
information on individuals holding Business Sustainment Roles has been provided to the CCIM Service Desk.
Instructions:
Step 1: Complete mandatory Section A.
Step 2: Complete mandatory Section B.
Step 3: Complete the subsequent applicable section(s) including required signatures and dates.
Step 4: Ensure the applicable HSP signing authority signs the form on page 4.
SECTION A: CURRENT HSP CONTACT INFORMATION (MANDATORY)
Instructions:
Enter the information of your HSP and proceed to Section B.
HSP Full Name:
LHIN:
HSP Address:
Facility ID:
For Internal Use Only
Does HINP have to set up new HSP account for IAR?
Yes
No
SECTION B: REQUEST TYPES (MANDATORY)
Instructions:
Step 1: There are four request types for managing your IAR accounts. Select one or more of the request types that apply.
Step 2: Complete the subsequent applicable section of this form.
1
Change HSP contact information
Complete Section C
2
Add, change and/or remove user accounts and permissions
Complete Section D
3
Add and/or remove static IP address
Complete Section E
4
Manage password resets and reactivations
Complete Section F
SECTION C: CHANGE HSP CONTACT INFORMATION
Instructions:
Step 1: In the “Information to Change” column, indicate the change to be made.
Step 2: In the “Previous Information” column, indicate the applicable old information.
Step 3: In the “New Information” column, indicate the applicable new information.
Information to Change
Previous Information
Please be advised that the submission of this form
may require follow-up to ensure the necessary details
are captured when the HSP details are changed.
New Information
HSP Full Name
LHIN
HSP Address
Facility ID
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SECTION D: ADD, CHANGE AND/OR REMOVE USER ACCOUNTS AND/OR PERMISSIONS
Permissions for IAR
Permissions for IAR must always be requested and authorized for each individual IAR HSP
IAR Permissions:
Viewer: User is able to view Integrated Assessment Records
Privacy: User is able to access privacy and security reports and audit logs in IAR.
Uploader: User is able to access IAR submission error logs
Instructions:
Step 1: In the “Request Type” column, select one or more request types that apply
Step 2: Enter the individual’s information in the appropriate remaining columns based on the request type
Note – Additional Lines:
You may insert additional lines for additional users.
Request
Type
User Name
User Email Address
User Telephone
IAR
Permissions
Viewer
Privacy
Uploader
Viewer
Privacy
Uploader
Viewer
Privacy
Uploader
Add New
User and
Permissions
Viewer
Privacy
Uploader
Viewer
Privacy
Uploader
Viewer
Privacy
Uploader
Viewer
Privacy
Uploader
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Request
Type
Contact
Information
Type
Current Information
New Information
Name
Change
User
Information
and/or
Permissions
User ID
Not Applicable
Email
Address
Telephone
Permissions
Request
Type
Viewer
Privacy
Uploader
User Name
Viewer
Privacy
Uploader
User Email
User Telephone
User ID
Remove
User
SECTION E: ADD AND/OR REMOVE STATIC IP ADDRESS
A static external IP address is required for an HSP to access IAR. Please ensure your static IP address is an external static IP address. If you
are unsure whether a static IP address is internal or external, check to see if it falls within one of the ranges listed below. If the static IP address
falls within one of these numerical ranges, it is an internal IP address and cannot be used to access IAR.



10.0.0.0 – 10.255.255.255
172.16.0.0 – 172.32.255.255
192.168.0.0 – 192.168.255.255
Instructions:
Step 1: In the “Request Type” column, indicate the type of request that applies.
Step 2: In the “IP Address” column, list the IP addresses being added or removed as applicable.
Request Type
IP Address
(Multiple IP addresses may be specified; please separate with a semicolon)
Static Viewer IP:
Add New Static IP Address
Remove Current Static IP Address
Static Uploader IP:
Add New Static IP Address
Remove Current Static IP Address
For HSPs who receive Standardized Reports, does the information affect the IP address used to access the Reporting Portal:
No
Yes - If Yes, please note the IP address
you will use to access your reports
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Not Applicable
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SECTION F: MANAGE PASSWORD RESETS AND REACTIVATIONS
Instructions:
Step 1: Select a separate row for each user request and indicate the request type in the “Request Type” column.
Step 2: Enter the individual’s information in the remaining columns as appropriate.
Note – Additional Lines:
You may insert additional lines for additional users
Notes for User Coordinator:
 Users can set up secret questions in IAR to support future password recovery. This allows users to reset their passwords electronically
without having to send in a reset request.
 Passwords will expire after 90 days and must be reset at that time and account must be reactivated.
Request Type
User Name
User Email
User Telephone
Reset User Password OR
Reactivate User Account
Reset User Password OR
Reactivate User Account
Reset User Password OR
Reactivate User Account
Reset User Password OR
Reactivate User Account
Reset User Password OR
Reactivate User Account
HSP SIGNATURES REQUIRED
If Section C and/or Section D and/or Section E are completed, the HSP User Authority must sign to authorize the change.
User Authority Name
User Authority Email
User Authority Telephone
User Authority Signature
Date
If Section F is completed, the HSP User Coordinator must sign to authorize the change.
User Coordinator Name
User Coordinator Email
User Coordinator Telephone
User Coordinator Signature
Date
Please complete this form in Microsoft Word have it signed and submit this form electronically to IAR@ccim.on.ca or fax to
416.314.1585
For any questions, contact the CCIM Service Desk at 1.866.909.5600 Option 8 or via email at IAR@ccim.on.ca
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