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MT01 - MediNet New User Account Application …

Form: GEN2514_T01_v1.6 effective 15 Feb 2018 MT01 - MediNet New User Account Application /Token Form Part A: To be completed …

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  Application, Account, User, Token, Medinet new user account application, Medinet

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Text of MT01 - MediNet New User Account Application …

Form: effective 15 Feb 2018 MT01 - MediNet New User Account Application /Token Form Part A: To be completed by New User (Fax/Email form as specified below) Application Method Fax/ Email Attn: Health Utilisation Dashboard (HUD) Email MOH Datahub HUD Admin Salary IT System Email MOH DataHub Admin MediClaim Email MediClaim Admin R-DAR Fax 6325 2600 Jip Kok Wine nGager Fax 6324 3735 NMRC OMIS Fax 6325 1677 Ju Peng Lwa MTS Fax 6325 9072 Ling Hui Ping BiosIS Email Biosafety Branch MITS Fax 6325 9484 MITS Front End System NPHURS Email Ms Flora Huang NMTS only Email NMTS Admin CMIS Email MOH IFC EMRX Email MOH IFC EQMS Email Wee Kheng How Please tick RSA Token* *Not applicable to New Users who apply for Mediclaim, Mediclaim PMI, Mediclaim MBE, MTS, CMIS and EMRX access. Name: _______________________________ OneKey Token/SMS NRIC: ___________________________ Email: _______________________________ Contact No.: ______________________ Organization Name: ________________________________________ ______________________ Organization ID (For MediClaim only:7 digits used for MediClaim login) :________________________ New/Existing Token Card Serial No. (Serial No. is engraved behind token card): ______________________ For OneKey Token/SMS: OneKey Token Series Number:_________________________________ Mobile Number of OTP:_____________________ NAF UserName:____________________________ *This is either NRIC or user created when you activate the onekey token at OneKey portal ( ). User may login to the OneKey portal to find out his/her NAF User name.) Existing NMTS User ID (For NMTS only):________________________ Access required (For NMTS only): MT only MT & FA Others _______________ Form: effective 15 Feb 2018 Application needed: (Please check the box) MediClaim MediClaim (PMI) MediClaim (MBE) R-DAR nGager OMIS MTS* BiosIS MITS CMIS EMRX Salary IT System NPHURS NMTS HUD NTRS NTRS TC Form EQMS Undertaking to Safeguard Information and Declaration of Security I understand and agree to the following: 1. The data required will only be used for the purpose specified. 2. No data will be disclosed to a third party without prior authorization from the Ministry of Health. 3. All necessary measures and precautions will be taken to protect the security and privacy of data. 4. To report loss of token card within 24 hours to avoid unauthorized access. Applicant s Signature: ________________ Date: :_____________ Part B: To be completed by MOH New Application User ID: _______________ Created Date:_____________ MOH to email completed scanned form to Part C: To be completed by MediNet Operations New / Existing Token User ID:________________ Created Date: ____________ MediNet Operations to inform Applicant upon activation of account (via email)

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