NEXT GENERATION ACUTE CARE TRAUMA REGISTRY ACCOUNT PLEASE

AGERELATED MACULAR DEGENERATION ASSESSMENT REFERRAL AND TREATMENT  OXFORD
13 REGULATIONS OF THE LITHUANIAN NATIONAL SECOND GENERATION SCHENGEN
2ND & 3RD GENERATION PUBLIC BICYCLE HIRE SCHEMES 1

30 REPRESENTING FUTURE GENERATIONS POLITICAL PRESENTISM AND DEMOCRATIC TRUSTEESHIP
32 REGENERATION AND HOUSING FUNCTIONS DELEGATED TO THE WEST
3G TR 22976 V100 (200003) TECHNICAL SPECIFICATION 3RD GENERATION

Secure FTP User Access Request


Next Generation - Acute Care Trauma Registry Account


Please complete the information below requesting the following person(s) be added as an Administrator for your trauma center in the Next Generation Trauma Registry (NGTR). Please complete the form and email a signed copy to the contacts listed below. As an Administrator, your role will be to add/delete, grant and maintain users’ access in the NGTR on behalf of your hospital.


Please print

Hospital Name: _________________________________________________________________

Address: _________________________________________________________________

_________________________________________________________________

Phone: _________________________________________________________________


Administrator

Name: _____________________________________

Title: _____________________________________

Phone: __________________________ __________ Ext. _ __

Email: _____________________________________


Contact 1 Signature __________________________________________ ______________

Date

Trauma Registrar Contact-

Name: _____________________________________

Title: _____________________________________

Phone: __________________________ __________ Ext. _ __

Email: _____________________________________


List all additional email(s)(up to seven) who should receive notifications regarding any submissions or reports status. Administrators will be included in the distribution list.

___________________________________ __


____________________________________ _


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For Internal use.



Date account set up and Administrator notified: ­­­­­­­­_______________________________


Signed: ­­­­­­­­­­­­_______________________________________

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For questions, please contact: Joshua Sturms, OPS Information Techology Analyst

(850) 245-4440 ext. 2836

[email protected]


or


Carma Harvey, Information Technology Analyst

(850) 245-4440 ext. 2731

[email protected]


3G TR 33901 V300 (199907) 3RD GENERATION PARTNERSHIP PROJECT
3G TS 23057 V1230 (19990708) TECHNICAL SPECIFICATION 3RD GENERATION
3GPP TR 32826 V100 (200912) TECHNICAL REPORT 3RD GENERATION


Tags: account please, date account, acute, generation, trauma, registry, account, please