How to complete BSHD SARF
Follow the guidelines below to complete the BHSD system access request form (SARF). Email the completed form to [email protected]
For the User Information section of the SARF highlighted below, we require you to enter a value for each field. For User Type, select County Contracted Provider and enter agency name.
For the Unicare EHR System Access section, we require you to enter a value in each field.
Note the directions here to submit a separate request to access Unicare remotely. To do this, complete and email Remote Access | Attachment A and IT User Responsibility Statement. You can bundle these documents with SARF in one email.
For the CCP User Request section, we require you to enter a value for each field.
The exception is Supplemental Access. Check the box if you require CC Inbox.To complete the myAvatar Job Function section, review the descriptions in the table below and depends if you use PCNX in myAvatar.
| myavatar job function | description |
|---|---|
PCNX Billing | FAST service entry submission |
PCNX Clinical SUTS | ALOC, ALOC QI, ALOC report, Referral disposition |
| PCNX Registration | Client admission, client discharge, financial investigation, financial eligibility, update client details, women’s health history, client diagnosis, CALOMS forms, CSI forms, CCP program availability, real-time 270/271 |