Medical Office-SAF

Security Access Form for Medical Office Staff (Not Physicians)

Please note new user account request requirements:
  • This account request will not be processed if any requested information is missing.  A new request form will be required.
  • There is a 3 day turnaround to process security access form (SAF) requests.
  • Token user requirements:
    • The new user is required to activate the provisioned token within seven (7) days of being issued.  User name and password will be issued AFTER the token is activated by the user and verified by the Local Security Coordinator.
    • Failure to comply with token activation requirement will result in termination of this account request.
Required Forms:
1. Medical Office Staff - New User Request Form
2. Confidentiality and Security Agreement
3. Physician's Office Staff Remote User Agreement (Exhibit A)

Fax three (3) required, completed forms to:
Fauquier Hospital
Medical Staff Services Office

For Reference:
Remote User Agreement for Physicians, Physician's Office Staff, and/or Contractors/Vendors, Policy 831-730

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