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Forms

  • Access Requests
  1. Access Request Form for Staff (non-MD Faculty only)
  2. Access Request Form for No UCPath Appointment in Semel/Psychiatry/NPH
  3. Access Request Form for Physicians/Faculty (MDs only)
  4. Access to Mednet Email During LOA (Leave Of Absence)
  5. AirWatch Enrollment Request for Cell Phones
  6. CareConnect – Clinical (new/change for non-MDs only)
  7. CareConnect – Research
  8. Change Request for Existing Mednet User (except CareConnect)
  9. DocuSign Access Request
  10. Mednet VPN
  11. Out-Of-Office Notice on Behalf of a User
  12. Request to Interface/Download Restricted Information
  13. Request to Interface/Download Restricted Information Internal Data Use Agreement
  14. Shared Mailboxes & Distribution Lists
  15. Semel Login ID for IDDRC User
  • Equipment Requests
  1. AirWatch Build Intake Form
  2. Laptop & Protected Health Information Policy Disclosure
  3. Mobile Devices & Removable Media Encryption Form
  4. General Workstation/Laptop Security Questionnaire
  5. Equipment Inventory Modification Request
  6. Loaner Laptop Request Form
  7. Relocation Request Form for Equipment & Phones
  8. E-Waste Request Form for Computer Equipment, Phones, & Other Devices
  9. iPad Loaner Request Form
  10. Third-Party Risk Management (TPRM) Assessment
  • Audio/Visual
  1. AV Service Request Form
  2. Video Upload Request Form
  3. AV Cart Loaning Program Request Form
  • Website Management
  1. Website Change Request Form
  2. Website Design Request Form
  3. Domain Name Request Form
  • Miscellaneous
  1. Box Consensual Access Form
  2. P-Card Order Form
  3. Request to Interface or Download Restricted Information
  4. Room Booking Account Request Form
  5. Social Media Contract & Application
  6. Software Installation Request Form

Reach out!

If you require any help, have inquiries, or would like to share your thoughts with the IT team, please don't hesitate to reach out to us!

You may send an email to NPIHDesktop@mednet.ucla.edu or you can fill out this form to get in touch with one of our team members.

Disclaimer: The statements on this page represent the views of UCLA Semel Institute Information Technology and do not necessarily represent the views of the University of California, or UCLA or its Chancellor. Privacy & Terms of Use

© 2024 UCLA Semel Institute Information Technology

Attention!

Applying for mednet vpn access?

Only supervisors/managers should complete this form!

Click here to proceed

Attention!

Applying for access request with no UCPath appointment?

Enter user's name.

Please SELECT ONE of the categories below that the user belongs to.

Note: If none of these apply to you, then you should not fill out this form.

For a definition of each category, hover over here!
CATEGORY DEFINITION
Affiliate A student or staff in non-UCLA Health department.
Contractor Meets BFB-BUS-77 Independent Consultant Guidelines https://policy.ucop.edu/doc/3220485/BFB-BUS-43 https://policy.ucop.edu/doc/3600670/Independent Contractor
Collaborator User who is a student or staff in other universities and is part of an IRB.
Intern User is not enrolled in any UC campus as student. Need access to participate in training or internship.
Volunteer Registered with UCLA Health Sciences Volunteer Program https://www.uclahealth.org/volunteer/ucla-health-sciences-volunteer-program

just making sure you're not a robot

Attention!

Applying for Research careconnect access?

Please contact Semel Research CareConnect at SemelResCon@mednet.ucla.edu.