Access Request/Change Form 2011
*** Surgeon Office Staff ***
Please complete this form and send to your HA SPR Administrator.
Note: Requests must be sent to SPR Central Office from a designated Health
Authority SPR Administrator.
For more information call SPR Office at (250) 519-5687 or e-mail to sproffice@phsa.ca
Surgeon Office Staff Name:
Surgeon Office Staff Phone Number:
Surgeon Office Staff E-mail:
Surgeon Name:
Surgeon’s College ID:
Health Authority:
Health Authority UserName:
HA SPR Admin. or Delegate:
Date Requested:
Change to existing User Access (Please indicate the change (s) required in this section)
ACCESS REQUIRED:
(To select an option double click on the check box and set default value to Checked.)
NEW SPR USER
SPR Production / SPR Data Mart (reporting) as Report Consumer
USER GROUP REQUIRED:
Surgeon Office Staff 2
SPR Central Office Use Only
SPR Manager or Delegate:
Date Received:
SPR UserID
Request Form Saved and Filed
Master Access List Updated
Distribution Lists (HO)
June 2011