Employee Type

Status

Employee ID

Employee Name

First Name

Middle Initial

Last Name

Initials

Contract Employee

Contract Facility/Company

Teams

Primary Team

SSN

Date of Birth

Start Date

Termination Date

Federal Tax ID

Taxonomy Code

NPI

Street 1

Primary Phone #

Street 2

Other Phone #

City

Cell/Work Phone #

State

Zip Code

GPS (lat, long)

Email Address

Primary Company

Primary Location

Employee Skills

Patient Characteristics

Zones

License 1 #

Valid From

Valid To

Description

License 2 #

Valid From

Valid To

Description

License 3 #

Valid From

Valid To

Description

License 4 #

Valid From

Valid To

Description

License 5 #

Valid From

Valid To

Description

License 6 #

Valid From

Valid To

Description

License 7 #

Valid From

Valid To

Description

Payroll Employee ID

Cost Centers

Primary Cost Center

Default patient related items to employee Cost Center?

Notes

User ID

Password

User must change password at next log in

User Account Status

Unlock

Restrict Patient Access

Mobile Device User

Access Type

User Types

Primary User Type

Signature User Type

Billing Access Filters

Apply filters on billing-related data presented to the user.

Location(s)

Insurances(s)

Programs(s)

Dial-N-Document Access

Access Code

Reset Dial-N-Document Password

Qualis Access

Has access to Qualis?

Influenza Vaccination Status

Last Date Gathered

Employee offered influenza vaccine?

Employee received the influenza vaccine from the agency?

Date influenza vaccine administered from the agency

Employee provided documentation indicating they received the influenza vaccine from a setting outside the agency?

Date influenza vaccine administered from a setting outside the agency?

Influenza vaccine administered by

Employee declined the influenza vaccine

Declined Reason

Other Declined Reason

Contact Links

Languages

Types

Skills

Restrictions

Locations