You will list the Primary/Parent Organization/Location first followed by each Sub/Child Organization/Location. The Sub Organization Form (Sub-Org) is completed electronically and is used to identify other locations that fall under the umbrella of the parent organization.
Register vip access License number#
If you are a Funeral Home, please include the license number and license type of each funeral director you enroll in the email. This form will be used in the future when submitting a new request for a VIP user account. This information is required to generate the VIP and VG user accounts.
The VIP User Request Form (URF) will need to be completed electronically by the access administrator with the details of each user of the VIP system in your organization and this form should be provided via email. Everyone associated with the VIP system will be required to read and sign the agreement including the access administrators. Each user will identify their functional role and agree to the terms and conditions stated on this agreement. The VIP User Confidentiality Form (UA) describes the terms and conditions for use of the VIP system. The certifier can also appoint anyone else they want as a secondary administrator. The medical certifier should be listed as an Access Administrator. 
The terms and conditions listed on the online form describes the responsibilities of the access administrator role such as submitting requests for user account creation, submitting requests for user deactivation, and reporting suspected fraud of the VIP system. The online form also identifies the access administrator as well as the backup access administrator(s). In the case of medical certifiers, the certifier should be the signatory and use his/her own name and title as the name of the Organization/Entity. The signatory level authority at your organization should read and sign the Services Agreement.
Register a New Virtual Gateway Organization online form located at defines the terms that apply to the organization’s access to the Virtual Gateway services. User accounts will be created for each username provided to access the VIP system, once the Registry has received all the signed agreements. User account processing takes up to 10 business days.Ī brief purpose of each agreement follows: Just a reminder: the information collected through the VIP system is highly sensitive therefore, it is imperative for the appropriate users to sign the legal agreements in order to gain access to the VIP system. Fill out a User Request Form listing all of the organizations users and Email it to Have each user sign a VIP User Confidentiality Form and Email the forms to your organization has multiple locations that are all run under the umbrella of the main organization you will need to fill out a Sub Organization Form XLS listing the primary location and all sub-organizations/locations. A separate User Request Form will need to be submitted for each location to specify which users have access to each individual location. Each individual user will need to fill out and sign a VIP User Confidentiality Form PDF | ( DOC). Go to Register a New Virtual Gateway Organization and complete the form. The enrollment process requires funeral homes, crematories, medical facilities, boards of health, and city/town clerks’ offices to have a signatory sign several agreements and fill out one electronic document in order to use the new VIP Deaths Module.
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