VIP A CCOUNT E NROLLMENT E LECTRONIC D EATH R EGISTRATION S YSTEM (EDRS) F UNERAL H OMES E DITION Massachusetts Dept. of Public Health Registry of Vital Records and Statistics WEBINAR - VIDEO VERSION

VIP A CCOUNT E NROLLMENT W EBINAR R EQUESTS Mute ONLY with the star 6 UnMute Only with the star 6 Please hold questions for the end

There are four forms to fill out Three on paper to be mailed to RVRS: 1. Virtual Gateway (VG) Services Agreement 2. Designation of Access Administrator Agreement 3. VIP User Agreement Registry of Vital Records and Statistics ATTN: Hansy Noel 150 Mt. Vernon Street, 1st Floor Boston, MA One form to be filled out in Excel and ed to RVRS 4. User Request Form

VG Services Agreement Virtual Gateway Service terms Contract between your organization and the Commonwealth. One per organization Submit the paper original

Designation of Access Administrator Agreement Identify your Access Administrator Access Administrator manages all of your users Document to be signed by your owner or director One per organization Submit the paper originals by USPS

VIP User Agreement RSVS user agreement terms and conditions. Every person is required to read and sign. One per or Administrator Submit the paper original

USER REQUEST FORM One per organization the Excel file from the ACCESS ADMINISTRATOR Access Administrator s the User Request to Required to generate the VIP and VG user accounts. Form is used for future user changes.

Virtual Gateway (VG) Services Agreement 1 Designation of Access Administrator Agreement 2 Vitals Information Partnership (VIP) User Agreement 3 User Request Form (to be sent electronically) 4 Overview of Steps

1 Virtual Gateway (VG) Services Agreement

Chapman, Cole, and Gleason Funeral Home David Chapman Director, President 8/23/2013 Chapman, Cole, and Gleason Funeral Home 2599 Cranberry Highway Wareham, MA VG Services Agreement Enter the name of person to receive a copy of the agreement and address David Chapman Enter the legal business or organization name followed by the tax ID #. Complete with signature of a person authorized to sign legal documents for the organization, printed name, title and the date

VG Services Agreement (Completed Sample) 1 Enter Name of Authorized Representative Enter Name of Organization Represented Enter Address of Organization 2 Enter the name of the Organization Enter the FEIN or Tax ID # Authorized signature of Representative Printed Name of Representative Date signed Leave the Commonwealth portion blank

2 Designation of Access Administrator Agreement

This information is the same as the VG Services Agreement (Page 1 of 2) Designation of Access Administrator Agreement The person who will be designated ACCESS ADMINISTRATOR signs followed by printing name and title Chapman Cole & Gleason David Chapman Director, President 8/23/2013 Christopher Berg Funeral Director

Designation Access Administrator Agreement (Completed Page 1 of 2) 1 User: Enter the organization name it is the name on the VG Services Agreement 2 Enter the FEIN # or the TAX ID of the organization 3 The authorized signatory of the organization signs and then prints name, title and dates the form 4 The person who will be designated ACCESS ADMINISTRATOR signs, then prints name and title

David Chapman David Chapman (Page 2 of 2) Designation Access Administrator Agreement Select to either designate or remove an Access Administrator The signatory of the organization fills this section in This is the information for the person you wish to designate the access administrator Designate a person as backup to ease future transitions David Chapman Chapman Cole & Gleason Funeral Home Chapman, Cole & Gleason Funeral Home 2599 Cranberry Highway Wareham, MA Christopher W. Berg Chapman, Cole & Gleason Funeral Home 2599 Cranberry Highway Wareham, MA William Morris Authorized Signatory Signs, Prints and Dates the Form

(Completed Page 2 of 2) Designation Access Administrator Agreement 1 An Authorized Signatory chooses to either DESIGNATE or REMOVE an ACCESS ADMINISTRATOR & provides contact info 2 Enter the name of the organization followed by its address and finally the name of the access administrator. Two 4-Digit pins must be made up and cannot include (1234, 0000) 3 This section should be completed to provide a backup ACCESS ADMINISTRATOR in the event the main person is unavailable and during times of transition. Complete the same as above 4 The authorized signatory of the entity signs granting above named person(s) Access Administration privileges'

David Chapman Chapman Cole & Gleason Funeral Home Chapman, Cole & Gleason Funeral Home 2599 Cranberry Highway Wareham, MA Christopher W. Berg David Chapman David Chapman Designation Access Administrator Agreement (Removal of Administrator) Select the remove option The signatory of the organization fills this section in This is the information for the person you wish to REMOVE as access administrator Authorized Signatory Signs, Prints and Dates the Form

3 VIP – User Agreement

(Page 1 of 2) VIP – User Agreement Christopher W Berg Chapman Cole & Gleason Funeral Director Enter the users’: Full Name Name of Employer Users Title Contact Number Contact Fill this form out for each user of the VIP System. Users may not share accounts.

(Completed Page 1 of 2) VIP – User Agreement 1 User reads terms and conditions of agreement 2 Enter the Users’ Name Employer Title Contact Number Contact

(Page 2 of 2) VIP – User Agreement Select the appropriate level of access for each individual user in this example we choose the fourth selection representing funeral homes The user then reads all agreement requirements and finishes with a signature and date Christopher W Berg 6/29/13

RVRS – User Agreement (Completed Page 2 of 2) 1 Choose the appropriate access being requested for User 2 User reads all 10 agreements 3 User Signs and Dates Form

4 Vital Information Partnership (VIP) User Request Form (URF)

Instructions: 1. All non-role fields are required. 2. Fill in form, put an "X" in the column with the requested action. 3. Save document as YourOrganizationName_MMDDYY. 4. completed form to: PLEASE SUBMIT ONE FORM PER Questions? Call the EOHHS Virtual Gateway Customer Service PHONE TTY

User Request Form We will break this down into three parts as this will be completed and submitted electronically as an excel file

Christopher W Berg Enter the name(s) of each user Enter 4 digit pin for user (pin CANNOT be 0000 or 1234) Enter User(s) Month and Day of Birth (e.g. May Twenty-fifth = 0525) Enter User(s) Work Enter User(s) Work Phone # User Request Form

X X Select from the list the proper group for the user(s) In this example we are selecting a funeral home data entry Select option to add or modify user(s) account User Request Form

Instructions: 1. All non-role fields are required. 2. Fill in form, put an "X" in the column with the requested action. 3. Save document as YourOrganizationName_MMDDYY. 4. completed form to: PLEASE SUBMIT ONE FORM PER Questions? Call the EOHHS Virtual Gateway Customer Service PHONE TTY David Chapman Chapman Cole & Gleason The Access Administrator finishes the User Request Form (URF) & Save document as described & Send the document to VIP Project team User Request Form

VG Services Agreement – Required for each organization accessing VIP and/or the EDRS Designation of Access Administrator – Required to establish and maintain access to the VIP and/or EDRS – A backup should be administrator is strongly recommended VIP User Agreement – Each individual person who will be accessing the VIP and/or EDRS is required to agree to the terms and conditions of the VIP system. – SHARING ACCOUNTS IS NOT ALLOWED User Request Form – To be ed by the Access Administrator from the account on file with the Virtual Gateway Checklist before submission

MAIL FORMS TO: Registry of Vital Records and Statistics ATTN: Hansy Noel 150 Mt. Vernon Street, 1st Floor Boston, MA TO:

T HANKS ! WE LOOK FORWARD TO J ANUARY 1 ST AND OUR NEW E LECTRONIC D EATH R EGISTRATION S YSTEM THE V ITALS T EAM QUESTIONS?

Quick Reference Guide VIP Enrollment FORMS Funeral Homes Registry of Vital Records and Statistics IGNORE ALL OTHER ADDRESSESS ATTN: Hansy Noel * USE ONLY THIS ADDRESS * 150 Mt. Vernon Street, 1st Floor Boston, MA BY PAPER ( * 3 weeks to process the set * ) VG Services Agreement – Contract between you and our MA IT Services * need your Tax Id # and level III or VI director to sign * Designation of Access Administrator – Manages user access, addition & removal * designate one, with one or more backup admins * VIP User Agreement – Every user promises to follow policies * every user acknowledges on paper * BY ( * 2 days to process * ) User Request Form – Access Admin manages users by excel &