Fillable CYFD Web Services External User Request Form for

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CYFD Web Services External User Request Form for

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1
CYFD Web Services
External User Request Form for EPICS CCS – JCC and DV
Providers:
Upon completion, this form is to be sent to cyfdepics.ccsdv@state.nm.us for Domestic Violence
services or cyfdepics.ccsjcc@state.nm.us for Juvenile Community Corrections services
*All fields must be completed for processing.
Request Information
(completed by Provider)
Date Request Submitted:
Type of Request:
☐ EPICS CCS access ☐ Remove EPICS CCS access
☐ Modify account info
If modifications, explain:
First Name:
Middle Initial: Last Name:
Gender:
☐ Male ☐ Female
Date of Birth:
Home Physical Address:
City: State: Zip:
Phone: Email Address:
Provider's Name: Provider’s EPICS ID:
Provider's Employee Submitting Request:
Provider's Phone: Provider's Email:
Approved user role(s):
(Check all that apply.
See descriptions below.)
☐ CCS External DV Data Unit
☐ CCS External DV Director
☐ CCS External JCC Data Unit
☐ CCS External JCC Director
***Approval***
(completed by CYFD Program Manager)
CYFD Program Manager: Upon approval, e-mail to SystemAccess@state.nm.us
Approved By: Date Approved:
***Information Technology Services Use Only***
Date Received:
Processed By: Date Processed:
Completed:
☐ 389 Directory Setup ☐ EPICS CCS Setup
☐ Update EPICS CCS Email Group
User Login ID:
Date login instructions was sent to Requestor:
2
The Request Information section of this form is to be completed by the provider of the individual
requesting access to EPICS CCS – DV and JCC. The individual requesting access must have a
unique e-mail address (not shared), as this is used to send login information to that person and
outage notifications. Upon completion, this form is to be sent to cyfdepics.ccsdv@state.nm.us for
Domestic Violence services or cyfdepics.ccsjcc@state.nm.us for Juvenile Community
Corrections services, for review and approval by the CYFD Program Manager.
EPICS CCS User Roles – Descriptions
Domestic Violence:
EXTERNAL DV DATA UNIT:
a) Read access to all DV Content but limited their provider content.
b) Create/Update: Clients, Locations, Intakes, Services, Staff, Group Services, Surveys and DV
FVPSA, Referral Source.
c) Generate Bill
EXTERNAL DV DIRECTOR:
a) Read access to all DV Content but limited their provider content.
b) Create/Update: Data Unit, Generate Bill and User Management.
Juvenile Community Corrections:
EXTERNAL JCC DATA UNIT:
a) Read access to all JCC Content but limited their provider content.
b) Create/Update: Clients, Intakes, Services, Staff, Group Services, Surveys and DV FVPSA,
Referral Source.
c) Generate Bill
EXTERNAL JCC DIRECTOR:
a) Read access to all JCC Content but limited their provider content.
b) Create/Update: Data Unit, Generate Bill and User Management.
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Completed 2 March 2021

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