The EIM/ESM User request form and Organization Management Template should be completed by an Access Administrator and e-mailed to the e-mail address on the form as an Excel document. Virtual Gateway Customer Service Call Virtual Gateway Customer Service, Virtual Gateway Customer Service at (800) 421-0938 TTY Call Virtual Gateway Customer Service, TTY at (617) 847-6578 For people who are deaf, hard of hearing or speech disabled. Organization Management Template - Form D Please note:.Please submit this User Request form after successfully passing all compliancy testing. This form is to be used only by those provider organizations approved to upload HIPAA files into EIM. File Transfer Service HIPAA User Request Form.Important : If an organization needs to update their legal name, change their address or merge with another organization, contact EIM/ESM User Request Form Organization Legal Name (Do Not Include Any of the following Special Characters such as & * + ( ) _ -).I am the parent or legal guardian of an existing pediatric patient and I would like to login to the Medical Use of Marijuana Online System. ![]() The following information is required to Register a New Virtual Gateway Organization: I previously registered as a the secondary caregiver for a pediatric patient via a paper application and I would like to claim my account to access the Medical use of Marijuana Online System. Register a New Virtual Gateway Organization Refer to EIM/ESM Instructions for more information. ![]() He or she is responsible for approving, modifying, and/or removing user access privileges for any of the VG's business services used by your organization. The Authorized Representative must designate an individual(s) to be their VG Access Administrator(s). ![]() An Authorized Representative is an individual who has the legal authority to sign on behalf of your organization, as evidenced by your organization's charter or bylaws. This information must be completed and submitted online by an Authorized Representative for your organization. Our 22,000 employees work hard to decrease health disparities, build a strong social safety net, fight hunger and food insecurity, address social determinants of health, support our workforce, and increase the accessibility and affordability of care. We provide access to medical and behavioral health care, substance use disorder treatment, long term services and supports, and countless nutritional and financial benefits. We connect older adults and individuals with disabilities with employment opportunities, housing, and supportive services.Īll told, EOHHS services and supports impact every single Massachusetts resident – and our agencies and programs directly serve 1 in every 3 residents.New Virtual Gateway providers going live with contracts on EIM/ESM for the first time need to submit their organization information using the online Virtual Gateway Organization Management webpage. We support individuals with intellectual and developmental disabilities older adults b lind, Deaf, and hard of hearing residents those struggling with substance use disorders, mental illness, or co-occurring illness refugees and immigrants system-involved youth survivors of sexual assault, domestic violence, and human trafficking and so many more people throughout the Commonwealth. The Executive Office of Health and Human Services works with many of Massachusetts’ most vulnerable residents. 85 1 Login and Navigation The MIIS is hosted on the Massachusetts Executive Office of Health and Human Services Virtual Gateway.
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