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at Columbus Public Health

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Epic Go-Live Support

The best way to get help and support during go-live week will be to reach out to a super user on your team.
If you cannot reach a super user, use the form below to contact a member of our team for support.

Support Options:

Find a super user (see the super user team list)
Reach the CPH support team via the form below
Call OSU Epic Support at 855-918-8886

Epic Support

What type of request would you like to make?

Type of Request

Password Reset

New User Access/Existing User Access

Hardware Support

Report/Data Request

Chart Correction

Merge Records

Change/Enhancement Request

Deactivate Accounts

OtherOther

Requestor Information

Name *

Name

First

First

Last

Last

Email

Phone *

Division *

Program *

Job Class Title

Floor Floor

Urgency *

Room # / Location

New User Information

Please describe your issue or request in as much detail as possible.

Name *

Name

First

First

Last

Last

Middle Initial

Middle Initial

City Email *

Desk Phone *

Division * Division

Program *

Job Class Title

Manager’s name *

User Permission(Name of co-worker with similar job responsibilities) *

Last 4 SSN *

Computer Username (eg. Tsmith) *

User Role * User Role

User Status *

Nursing Credentials (Complete as applicable)

Ohio Medical License #

NPI

DEA

Certificate to Prescribe (CTP)

Reason for Access Request (check all that apply)

Patient Treatment

Registration

Scheduling

Coding

Billing

Ryan White Case Management

OtherOther

IMPORTANT

1. The New/Existing User will receive Confidentiality Agreement attachment via city email after submitting the ticket.
2. Supervisor please have New/Existing User print their full name and sign the “Confidentiality Agreement” form using Acrobat Reader. Follow instructions linked to “Action Required” email for electronic signature.

Report/Data Request

Type of Request * Type of Request

NextGen Program * NextGen Program

Report Title

Password Reset

Password Reset Type *

Device you are using *

Merge Duplicate Records

Client First, Last Name (#1) *

MRN (#1) *

DOB (#1) *

Last four of SSN(#1) *

Client First, Last Name (#2) *

MRN (#2) *

DOB (#2) *

Last four of SSN (#2) *

Record to Keep *

# 1

# 2

Patient Information

Client Name *

DOB *

MRN # *

Last four digits of SSN *

Encounter to Delete

Date *

Time *

:

Encounter Number *

Encounter to Keep

Date

Time

:

Encounter Number

Manager’s approval required to complete request

Manager’s Email: *

FOR MANAGER ONLY: Approve this change request?

I approve this request

I deny this request

Type Your Name *

Type Your Name

First

First

Last

Last

Signature

Additional Comments (if necessary)

Deactivating Account Information

Name *

Name

First

First

Last

Last

Email

Effective From *

Username *

User Role * User Role

Program *

Deactivate Accounts * Deactivate Accounts

Reason for Deactivation * Reason for Deactivation

Other Request

Describe your request

Upload a photo or screenshot (if applicable)

Maximum file size: 10MB

If you are human, leave this field blank.

This page is updated regularly. Please check back for the latest updates and guidance about this and other Information Technology topics.