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Parkview Business Associate Request

Getting Started

If you are a PH employee, in a position of authority, you may request to sponsor an outside consultant/contractor to have access to PH resources when the access will benefit Parkview Health. This access will be granted on a Need to Know basis and the access given will only be for the individual to perform jobs or tasks in connection with Parkview Health. This access will include but not be exclusive to PHI.
 
If the above fits your need, please complete the four steps below to set up an account. Through a secure connection, Parkview will receive your signed request, verify eligibility and confirm access. If you have questions or need assistance, please contact our IS Service Center at (260) 266-8600 or E-mail: accessprovisioning@parkview.com
 
1.       Complete the request for access form
To initiate the request for access, please use the link listed below to provide valid e-mail addresses for the Parkview Sponsor (first line) and for the Outside individual who is to receive account access (second line).
 
2.       Complete the request for verification form
In return, a request for verification form will be e-mailed to the Parkview sponsor. Required fields are outlined in red. The Parkview sponsor will electronically sign the Business Associate request e-form. Note: All electronic forms not signed within 30 days will expire and have to be resubmitted for access.
 
3.       Read the Access Agreement
Next, the “Protected Health Information Access Agreement” will be e-mailed to the individual who is to receive account access. The recipient will need to read the agreement in its entirety. If the recipient agrees with the terms of the agreement, the recipient will need to electronically sign the agreement by entering their name to agree to the terms and conditions.
 
4.       Allow 7 days to setup the account
This process will take 7 business days. Once your account is set up, the Parkview sponsor will receive an e-mail with the ID and password. 
 
Click here to complete the Parkview Business Associate Form.