ACCURO & CITRIX USER MANAGEMENT FORM

Please Select One: Add New User Remove User* Edit User Suspend User** Clinic Name: User Full Name: Accuro Username Requested: Citrix Username Requested *if different than above: Accuro Password Requested: Citrix Password Requested *if different than above: Start Date: Change / Remove Date: **If suspending user enter first day away as start date and first day back as Change / Remove Date *If you terminate a user account, all information stored in private folders will be removed

Accuro Role/Permissions Role/Position at Clinic same as user: or Access to: All EMR Billing Scheduling Reporting Patients Labs System Administrator Access? Yes No *Having at least one sys admin in the office can be useful for internal password resets, etc but does have the power to make global changes. Access to the following Provider(s) Please list all providers you wish to provide access to or simply ‘all providers’ - - - Sites: Please list all offices that require access if more than one - - Does your office use single sign-on? Yes No Unknown Does your office use SunRay terminals? Yes No Unknown If yes, is a smart card required? Yes No Unknown Special Instructions: May include daily tasks here to ensure proper level of access is given

Your Name: Date:

Please return via fax to: 1.866.421.9332