№ files_lp_3_process_9_32176
Administrative request form for obtaining or modifying access to the DMHAS Critical Incident application and secure network, including user identification details, facility authorization, and a signed confidentiality pledge under applicable privacy regulations.
Organization: Department of Mental Health & Addiction Services (DMHAS)
Region: State of Connecticut
Document Type: Administrative Form
Subject: CI Access and VPN Token Request
Related System: Critical Incident (CI) Application
Related Network: DMHAS Secure Network
Associated Regulation: HIPAA and State of Connecticut and Federal privacy regulations
Contact Person: Chrishaun Jackson
Help Desk: DMHAS Information Technology Help Desk
Required Signatories: Requester and Facility CEO or Designee
Submission Method: Fax
Acceptance Conditions: Typed, complete, current, non-emailed forms only
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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