axiUm/MiPACS New User Request Form
Please fill out the information below to request access for axiUm and MiPACS. If you need assistance filling out this form, please call the SOD IT Helpdesk at (612) 626-3506. Asterisk (*) indicates a required field. All required fields must be filled out before access can be granted.

PLEASE NOTE: ACCESS CANNOT BE GRANTED BY THE IT STAFF until HIPAA training is complete.

User's First & Last Name:
Your answer
Email Address:
Your answer
Employee ID:
Your answer
Start Date:
Your answer
End Date/Graduation Date:
Your answer
Name of Equivalent User:
This will help IT staff determine the level of access needed for axiUm.
Your answer
List the axiUm reports the user will need access to:
Your answer
Will this person need the ability to access axiUm from home (typically reserved for faculty, residents, and student providers)?
Location
Where will the employee most often report to work (Moos, GPR, or UMP)?
Your answer
Notes/Special Instructions
Is there anything else we should know?
Your answer
User Type:
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