Associate Identity Request Form (A.I.R.)
Demographic Information
The Associate Identity Request Form (A.I.R. Form) is used to validate information about a user from a Kaleida Health Partner. When the A.I.R. form is received, CyberSecurity will submit the request to the Partners Organization Approver for approval and to the Kaleida Health Manager for approval. Upon approval, the user will receive a Kaleida Health "Associate" number. The “Associate” number will entitle the user to certain resources within Kaleida Health.
If you need assistance, please contact the Kaleida Health Service Desk at 716-859-7777.
Proceed
Demographic Information
First Name
Please provide a valid name.
Middle Initial
Please provide a valid middle initial.
If no middle initial, please check this box
Last Name
Please provide a valid name.
Suffix
(optional)
Last four digits of SSN
Please provide a valid SSN.
If you do not have a SSN, please call the Technology Assistance Center at 716-859-7777 as this information is used for validation purposes
Date of Birth
Please select a valid date.
Primary Email
Please provide a valid email.
Primary Phone Number
Please provide a valid phone number ###-###-####.
Next
Organization Information
Organization
Choose an Organization
--- Organization Not Listed ---
3M
Abbott ITS
Absolut Care Aurora Park
Absolut Care of Orchard Brooke
Acacia Family Health
Acara Solutions
Account Review Svc
Accountable Healthcare
Accountemps
Accruent
AccuNet Solutions
Adult Medical Services
Advanced Cardiology
Advanced Pain Wellness Ins
Advent Health Partners
Aerotek
Aetna
Akron Family Care
Alan Barcomb
Albany College of Pharmacy
Alden Medical Group
Alfred Fast
Alfred State
ALKU
All Care for Women
Allegany Cnty DOH Early Interv
Allegany County ICM
Allegany Rehab Associates
Allentown Pediatric Adol
Allscripts
Allyn Norman
Alzheimers Association of WNY
Amedisys Home Care
American Heart Assoc
American Medical Response
American Traveler
Amerigroup BC/BS
Amherst Assc Oral Maxill Sgry
Amherst Associates of Oral
Amherst Ear, Nose & Throat
Amherst Medical Associate
Amherst Pediatrics
Amherst Sleep Medicine
Amherst Southgate ENT
Amherst Surgical Associates
Amherst Tonawanda Podiatry
AMN Healthcare
Anesthesia Business Consultant
Anil Kumar Mathur
Antelope Valley Com Clinic
Anthony Perna
Antionette Lukasik DDS PLLC
AP Professionals
Arie Weinstock
Arrant Surgical
Artemis Center for Health
ARTESIA PLASTIC SURGERY
Arthritis Asssociates
Artificial Intelligence in Med
Arvind Wadhwa
Ascend Software
Ascom Wireless
Ashley Kremer MD
Aspire of WNY
Aspire Technology Partner
Assertive Medical Practice
Associated Physicians of
Associates Training Dev
Aston Williams
ATS Bergamo
Attica Family Care
Audubon Women's Med Assoc.
Aueras Medical
AUM OB/GYN Associates
Aurora Family Health Care
Aurora Smiles Pediatric Dental
AVAAP
Avaya
Aya Healthcare Agency
Baker Victory Services
Banas, Kenneth MD
Bankstreet College
Barnes Family Care Associates
Bartels, Powalski. Weissman
Batavia Family Care
Batavia Health Care
Baxter
Beacon Solutions Group
Beechwood Continuing Care
Benedictine University
Bennett Health & Wellness
Bertrand Chaffee Primary Care
BestSelf Behavioral Health
Boces 1
Boces Orleans Niagara
Boston Scientific
Breast Care of WNY
Briody Health Care Facility
Brooks TLC Hospital Syste
Broome Community
Brothers of Mercy
Bryant and Stratton Buffalo
Buf Public Sch Adult Ed
Buf Public Sch Career Tech Ed
Buffalo Acutes
Buffalo Cardiac Surgical Assoc
Buffalo Cardiology & Pulmonary
Buffalo Center of Arts Tech
Buffalo Endo & Vasc Surg Assoc
Buffalo Endocrinology
Buffalo Endovascular
Buffalo ENT Specialists
Buffalo Gastroenterology
Buffalo General Cardiothoracic
Buffalo Healthcare Networ
Buffalo Hearing Speech Center
Buffalo Heart Group
Buffalo Medical Group
Buffalo Neuroimaging Anal
Buffalo Neurosurgery Group
Buffalo Niagara GI
Buffalo Niagara Plastic Surg
Buffalo Niagara Retina
Buffalo OB/GYN
Buffalo Orthopaedic Group
Buffalo Othopedic Brace
Buffalo Otolaryngology
Buffalo Pediatrics
Buffalo Pharmacies
Buffalo Prenatal Perinata
Buffalo Rheumatology
Buffalo State
Buffalo Thoracic Surgical Asso
Buffalo Urban League
Buffalo Vascular Care
Burnett Health Care
Burns & Hage
Campbell University
Canalside Primary Care
Cancer Care & Hematology
Cancer Care Mohamed Ahmed
Cancer Center of WNY
Canisus College
Cantalician Center
Canterbury Woods
Capturenet
Cardiology Group of WNY
Cardiology Reading Panel
Cardiovascular & Thoracic Surg
Care Everywhere LLC
Care Team Solutions
Carecentrix
Carefusion
Carestream
Carrow Street Pediatrics
Case Western
Catholic Charities of Buffalo
Catholic Health Systems
Cattaraugus Cnty DO Community
Cattaraugus Cnty DO Social Svc
Cattaraugus Cnty DOH
Cattaraugus Indian Reservation
Cattaraugus Rehab Ctr
CBCS
CCS Medical
CCS Oncology
CDWTechnologies Inc.
Cedar Peds
Center for Digestive
Center for Elder Law & Justice
Center for Orthopedics Degraff
Center for Plastic Surgery
Centers Health Care
CenTrak
Century Airport Peds
Cerner
CGF Anesthesia
Chamberlain College
Change Healthcare
Chatham University
Chaudhuri Physicians
Chautauqua Cnty DOHHS
Chautauqua Cnty DOMH
Chautauqua County Home
Cheng Shung Fu & Gracie Lin Fu
Chestnut Ridge Family Practice
Child Family Services
Child Adolescent Trt Svc
Child Care Resource Network
Children's ENT, PC
Chouchani, Syyegh & Bagnarello
Christopher Beney MD
CIOX Health
Cipher Health
Clarus Linens Systems
Cleveland Clinic WOC Nursing
Cleveland Hill Medical Group
Clifford Family Practice
Clinical AI Solutions Inc
CloudMed Solutions
College of Osteopathic Med
Communication Resources
Community Missions Niag Front
Community Svc Develop Disab
Compass House
COMPEER
Complete Home Care
Complete Senior Care
Comprehensive Dialysis of WNY
Comprehensive Rehab of Wl
Computer People Staffing
Constantine Karakousis
Continuum By DeRoyal
Coram Specialty Infusion
Core Medical Group
Core Security
Corning Community
Corporate Care Management
Cross Country Staffing
Crystal Springs Medical
Cushman Wakefield
D'Youville
Daemen
Dale Deahn MD
DataFirst
David Avino
David J Novelli MD
David Kraus
David P. Kowalski, MD
David Stahl MD
Davita Healthcare Partner
Davite Kidney Care Center NF
DeGraff Geriatric Center
DeGraff Wellness Center
Delaware Center Nursing Rehab
Delaware County Com College
Delaware Pediatrics
Delaware Surgical Group
DeNardin Family Practice
Dent Neurology
Derby Pediatrics
Dian Sutter
Diane Morrison
Diane Sanfilippo MD
Digestive Health Physicia
Diversified Agencvy
Divurgent
DLC Pediatrics
Donald Copley
Donald Largo
Donald Robinson
Dr Eric Roger
Dr. Louis Surace
Dr. Ronald Clarke Family Med
Dr. William M Healy
Draeger Medical Inc ONE
Dunkirk Pediatrics
Dunkirk Rehab & Nursing
Duquesne University
Ear, Nose, & Throat Care WNY
East Aurora Family Practice
East Aurora Pediatrics
East Coast O&P Corp
East Side Nursing Home
Eastern Niagara Hospital
ECC City
ECC North
ECC South
ECMC
Eddy Capote
eHealth Technologies
EILEEN K KOSIERACKI
Elderwood
Elizabeth Strell
Elma Primary Care
Elmira College
Elmwood Health Center
Emerald Buffalo
Empire Cardiology
Empire State College
Encompass Health
Encore Health Resources
Endeavor
Endion
Endo Center of Niagara
Endoscopy Center of WNY
Ensemble Health Partners
EOS-CCA
Eric Roger
Erie Cnty DOH
Event Artistry
Evergreen Health
Excellus
Excelsior Orthopaedics
Executive Health Resources
Eye Care and Vision Associates
Eye Health Associates
Family and Children Advocacy
Family Care Center
Family Care Medicine
Family Care Physicians
Family Choice NY
Family Health Medical Services
Family Help Center
Farkad Balya
Fastaff Traveling Nurses
FDA
FDR Medical Services
Federico Gonzalez-Doldan
Ferguson Electric
Fiddler's Green Manor
Fidelis Care
FIKA Midwifery
Firestorm
First String Healthcare
Five Star Family Care
Flagship Solutions Group
Flexcare
Forestream Pediatrics
Fortified Health Security
Fortus Group
Fox Run at Orchard Park
Frank Ferraro
Frank Laurri Sam Sirianni
Frank Voelker
Frederick Piwko
Fredonia
Fredonia Pediatric Dentistry
Freed Maxick
Frontier Surgical
Fugitt & Lillie
Fujifilm Medical Systems
Fusion Medical Staffing
GA Family Services
Gannon
Garden Gate
Gastroenterology Associat
Gateway-Longview
GBUAHN
GE Healthcare
Gemmson Oo
General Data
General Motors Corp.
General Physician PC
Genesee Cnty DOH
Genesee Cnty Emergency Service
Genesee County Nursing Home
Genesee-Transit Pediatrics
Geness Cnty DOMH
Genessee Community
George A. Haddad MD
George Narby
Geriatric Center of WNY
GHX Global Healthcare Exchange
Giuseppina Kenyon Savard
Global Healthcare IT
Golden Living Centers
Gosy & Associates
Gowanda Ambulance Service
Gowanda Rehab & Nursing
Grand Canyon
Grand Island Family Practice
Great Lake Inst of Tech
Great Lakes Anesthesiology OCH
Great Lakes Cardiovascula
Great Lakes Medical Imagi
Great Lakes Orthopedic Lab
Great Lakes Orthotics
Greater Buffalo United Account
Greater Niagara Medical Group
Green Security LLC
Greenkey
Grider Family Health Center
Growing Smiles Ped Adol Dent
Gulam Najar
Gynecology Oncology Assoc WNY
Hak Ko
Hamburg Family Medicine
Hampton University
Han Kyo Chang
Hanel Storage Systems
Harbour Health Hawthorne
Harmony Health Care
HarpData
Harris Hill Nursing Facil
HCF/Bradford Manor
HCT Agency
Health Home Partners of WNY
Health Integrated
Health Now BC/BS
Health System Services
Health Tec Solutions
Health Touch
Healthcare Solutions
Healthcast
Healthy Transformations
Heathwood
Heritage Christian Servic
Hewlett Packard
Highgate Medical
himagine Solutions
HOLIDAY PEDIATRICS PLLC
Home Resp Care
Homegrown Pediatrics PLLC
Homespace
Hospice Buffalo
Hospice Chautauqua
Host Healthcare
Houghton Rehab Center
HPG Resources
Huron Consulting Group
HyBridge Solutions
Ilja Weinrieb
Imagine Staffing
Imprivata
Independent Health
Indra Tambar
Infinity Medical of WNYHO
Infor
Insight Health Corp
Inspire Dental Group
Inspired Health Group
Instream LLC
Instrumentation Laboratory
Integrity Health/Tonawanda Ped
Internal Med ID
Internal Medicine Associates
Invision HealthBrainSpine
InVue Digital
IPC Hospitalists of WNY
IPRO Surveyors
Irons Inc
iSchemaview INC
Ithaca
Jacobs Neurological Institute
Jahangir Koleini MD
James Hohensee
James Pilc
Jameston Community
Jamestown Pediatrics
Jamestown Primary Care
Jamestown Rehab
Janet Westenberger
Jantz
Jayaselvi Kolli
Jean Jurek Associates
Jennie B Richmond Nursing
Jericho Road Family Pract
Jewish Family Service Buf
JH Enterprises
Jim Grigsby Consulting
Joel Bernstein
John DeBerry
John Fabian
John Visco
John Ward MD
Joseph Gentile
Joseph Ralabate
Kalmuk Primary Care
Kalos Health
Kamil Alpsan MD LLC
Karen Giardino
Kaul Pediatrics
Kelly Services
Ken-Ton Family Care/IPC
Kenmore Family Medicine
Kenneth Zimmerman
Keuka
Key Management Group
Keystone Perfusion
Kidney & Hypertension PC
Kids Alliance Pediatrics
Kings College
Kinkel Neurologic Center
Knee Center of WNY
Komal Chandan
KPMG
Kronos
L5 Scribes LLC
Lake Erie Col Osteiopathi
Lakeshore Family Medicine
Lakeshore Primary Care
Lancaster Depew Pediatrics
Lancaster Medical Group
Land Mark Care at Home
Landmark Medical NH
LANStatus
Latus Medical Care
Leaders for Today
LeMoyne College
Leroy Village Green
Lester Sielski
Lewiston Cardiology
Liberty Solutions
Life Safety Security
Lifetime Health
Lighthouse Free Medical Clinic
Limestone Family Care
Lisa Kenney
Lockport Pediatrics
Logix Health
Louis Surace
Loyola University Maryland
LRS Healthcare
Lumedx
Lutheran Home Rehab
Lynne Ross
Main Gastroenterology
Main Pediatrics
Malissa Larson Doula Srvc
Manpower
Maple Ayer Medical
Maple Gate
Maple Med Peds
Maple Medical Services
Marc Kozinn
Margaret Libby
Marietta College
Mark E Swetz MD PC
Mark Finkelstein
Mark Mieth
Martin Casey
Marywood University
MASH Urgent Care
Masimo
Maurice Gelia
Maxim Healthcare Services
McGuire Group NH
McKesson
MCPHS University
MCR Technologies
MDS Consultants
Meadow Family Medicine
Med Assets Agency
Med Pro Staffing
medaille College
MedCom Solutions
MedCor Staffing
Medical Decision Network
Medical Management Servic
Medical People Staffing
Medicity
MediCor Associates
Medina Memorial Hospital
MedManagementLLC
MedMatica Consulting
MedPartner
Medtronic
MedWell Niagara
Mercy Comprehensive Care Cntr
Mercy Flight
Mercyhurst College
Meridian IT Inc
Merril Dayton
Metz Corp
MF Surgery Center
Michael Bloom MD
Michael Izzo
Michael Merhige
Michael Vasquez
Michelle Braun
Mid Erie Counseling Trtmn
Millenium Travel Nursing
Millennium Collaborative
Mobile Health Care
Mobile Primary Care
Mohamad-Zahi Kassas MD
Mohamed Ahmed
Molina Health Care
Monroe Community College
Monroe Plan for Medical Care
Morehouse School of Medicine
Mount St Mary's
Mountain State
MVP Healthcare
My Brain & Spine Center
Narenda Kansal
Narendra Kansall, MD
Nash Pharmacy
National Decision Support
National Inst of First Assist
Native American Corn Svc
Nazareth
Neighborhood Health Ctr
Nephrology Associates
Netapp
Neuro Alert
Neuropsychology SVCS Degraff
New Directions
Newfane Rehab Healthcare
Nexera Inc
NFMMC
NFMMC Health Home
NFMMC Residency Program
Nia Rehab and Nursing
Niagara Cnty DOH
Niagara Cnty DOMH
Niagara Cnty Early Intervent
Niagara Community
Niagara Family Medicine
Niagara Hospice
Niagara Lutheran Greenfie
Niagara Lutheran Humboldt
Niagara Nephrology
Niagara Neurology
Niagara Primary
Niagara Pulmonary & Sleep Med
Niagara Rehab Nursing Hom
Niagara University
Nightingale Agency
Nihon Kohden USA
Niswander Eye Center
Nora Meaney-Elman
Norman Fiorica
North West College
Northeast Ohio University
Northeastern University
Northtown Orthopedics
Northtowns Cardiology
Northtowns Medical Group
Northtowns Oral Surgery
Northwell Health Laboratories
Northwest Buffalo Communi
Nova
Nuance Communications
NYS Dept of Corrections
NYS Dept of Health
NYS Office of Mental Health
NYS Veterans Home at Batavia
NYSD Family Assistance CPS
Oakland University
OB/GYN Associates of WNY
OConnor Medical Group
Oculys Health Informatics
Odd Fellow Rebekah Rehab
Ohio Northern Pharmacy
Ohio University
Oishei Healthykids
Olean Cardiology, PC
Olean Medical group
OLV Family Care Center
OMNI OB/GYN
Optimum Physician Alliance
OptionCare
Optum Alorica UHC Subsidiary
Orchard Manor Rehab
Orchard Park Family Practice
Orchard Park Pediatrics
Orchard Rehabilitation NC
Orion Health
Orleans County DOMH
Orthopedic Surgery, PC
Our Lady of Peace
Outsource Group
Oxford Healthcare Technology
Pamela Stevens
PAR Excellence Sys
Parkview Primary Care Phys
Patchwork Pediatrics
Patient Pathways
Patricia Danaher MD
Paul M Volansky DDS
Paul Nasca
Paul R. Young MD
Paul Wopperer
Pediatric Cardiology Assoc WNY
Pediatric Dental Care
Pediatric ENT Associates
Pediatric Surgical
Pediatric Urology of WNY
Pembroke Family Medicine
Penn State University
People Inc
Perry, Robert, Joel Paull
Philadelphia College of Med
Philip Fu MD PC
Philip Penepent
Pinnacle Orthopedic & Spine
Planned Parenthood/WNY Peds
Plattsburgh SUNY
Podiatry Affiliates
Ponce University
PPR Travel Nursing
Practice First
Practice Management
Precision Healthcare
Premier Genesee
Premier OB/GYN
Presidio
Primary Care of WNY
Primary Systems Inc
Professional Emergency Svc
PT Professionals
Pulmonary Group of WNY
Pure Life Renal of Buffalo
Pure Podiatry of WNY
Purely Pediatrics
Quadramed
Quaker Medical
R & B Medical Group
Rainbow Pediatrics
Rajiv Parikh
Rama Bojedla
Registry Partners
Reliable Project Management
Reliant Medical
Resource Center Primary Care
Revint Solutions
Richard Castaldo
Richard Ferguson
Richard Schifeling
RIT
River Road Primary Care Center
RMB Collection Agency
RN Network
Robert Miletich
Robert Wesleyan
Rocky Vista University
ROI Health Solutions
Ronco
Rosalind Franklin University
Ross Eye Institute
Roswell Park
RPM
Ruth Johnson
SA IT Services
Salamanca Rehab Nursing C
Salamanca/Olean Fam Hlth Cntr
Samuel Sirianni & Frank Laurri
Sarah Minnie Badger Foster Car
Sarwat Khawar
Say Yes to Education
Schoellkopf Health Center
Schofield Care
Scribes America
Sedona Holistic Medical Centre
Select One
Select Specialty Hospital
Seneca Nation Health System
Seton Hill University
Shalom Press
Sharma Family Medicine
Sheridan Medical Group
Shirley Anain, MD
Siemens
Sightrite
Silver Creek Pediatrics
Simmons Ortho & Spine Assoc
Sirius Com
Skaggs School of Pharmacy
Sleep and Wellness Center
Sleep Medicine Centers WNY
SmartEdge USA
Smiths Medical
SMP Corp
Snyder OB/GYN
Sodexo
Soliant Health
Soniwala Hematology Onc Ass
Southgate Medical Group
Southtowns Ambulatory Surgery
Southtowns Asthma & Allergy
Southtowns Cardiology
Southtowns ENT
Southtowns Family Practice
Southtowns Gastroenterology
Southtowns Internal Medicine
Southtowns Pediatrics
Southtowns Radiation Oncology
Southtowns Radiology Assoc
Southtowns Surgery Center
Southwestern Med Associates
SP Mohameed Ibrahim
Spectrum Human Services
Springville Pediatrics
Srong Perinatal Associates
St Catherines Laboure Healt CC
St Francis University
St John Fisher
St. Jude Medical
St. Vincent Health Center
Starflight
Stoltenberg Consulting INC
Stonybrook
Strategic Interests
Stryker
Stutzman Addiction Treat Cntr
Suburban Cardiology
Suburban Pediatrics
Suburban Women's Healthcare
Summit Family Health Center
Summit Health Care Soluti
Summit Pediatrics
Sunrise Pediatrics
SUNY at Cobleskill
SUNY at Delhi
Superior Group
Supplemental
Supportive Medical Partners
Surgical Associates of WNY
Surgical Solutions
Sweden Valley Manor
Swisslog Healthcare
Synaptive Medical
T2 Tech Group
Taylor Communication
Tejinder Kalra
TEK Systems
Teletracking
Telexy Healthcare
Temple University
TenEleven Group LLC
Terrace View LTC ECMC
Test RoadsideDiner
TestOrg
The ARC Erie County
The Bristol Home
The Chartis Group
The College of Saint Rose
The Leardini Group LLC
The Pines Healthcare Rehab
The Resource Center
The SUMMIT Center
The Villages of Orleans Health
Thomas Cumbo, MD
Thomas Dougherty MD
Thomas Hughes
Timeless Medical Systems
Timothy F Gabryel MD PC
TLC Health Network Lakeshore
TMO Medical PC
Today's Option APS Health
Tonawanda Medical Practice
Tonawanda Pediatrics
Town & Villiage Pediatrics
TransUnion
Travel Nurses Across America
Tri-County Family Medicine
Trinity Medical of WNY
Trinity Pediatrics
Trocaire
Trusted Nurse Staff
Tufts School of Medicine
Turner Construction
Turnkey Pharmacy Solutions
TVR Communications
Twin City Ambulance
Twin Tier
UB Clinical & Translational
UB Dermatology
UB Division Cardio Medicine
UB Family Medicine
UB General Surgery Residency
UB Gynecology Obstetrics
UB Health Services
UB MD
UB Neurology
UB Neurosurgery
UB Nuclear Medicine
UB Ophthamology
UB Oral Maxillofacial
UB Orthopedics Sports Med
UB Otolaryngology
UB Pathology & Anatomical
UB School of Pharmacy
UB Surgeons
UB Surgery Vascular Lab
UBMD Urology
United Health Care
Univera
University Dermatology
University Medical
University Nuclear Medicine
University of Buffalo
University of Findlay
University of Florida
University of Pittsburgh
University of Rochester
University of Utah
University of Western Ontario
University Ophthalmology Svc
University Orthopeaedic Svc
University Pathologists
University Pediatric Dentistry
University Pittsb at Bradford
University Psychiatry Practice
University Surgery Vascular
University Surgical Associates
Unyts
UPA
Upper Allegheny Health Sy
Upstate Cardiology
Upstate Home Care
Upstate Medical
UR Batavia Primary Care
UR Medicine
Urban Family Practice
Utica
Vatica Health
Venous Institue
Villa Maria College
Village Pediatrics & Rheum
VIP Primary Care
Vital Images
VNA Corridor Group
VNA of Northwest PA
Volunteer Service
Vyaire Medical
Warsaw Pediatrics
Waterfront Center
WCA
Weinberg Campus
Wellcare Health Plans
Wellness Medical Practice
Wells Gastro
Wellsville Manor Care Center
Wellsville Pediatrics
West Virgina University
Western University
Westfield Family Physicians
Wheatfield Family Medicine
Wheatfield Pediatrics
Wicks Educational Assoc.
Will Rosena DPM
Willcare Home Care
William Belles
William Cecere
William Todd Wallens
Williamsville Pediatrics
Williamsville Prim Care Cntr
Windsong Breast Surgery
WNY Breast Health
WNY Childrens Psychiatric Cntr
WNY Dental Group
WNY Dialysis
WNY ENT
WNY GI Connection
WNY Knee & Ortho Surgery
WNY Medical
WNY MEDICAL MANAGEMENT
WNY OB/GYN
WNY Ophthalmology
WNY Pediatrics
WNY Plastic Surgery
WNY Primary Care Medicine
WNY Radiology
WNY Rehab Med & Pain Man
WNY Retina
WNY Rheumatology
WNY Urology
WNY VA Healthcare System
WOC Nursing Ed Cleveland Clin
Wolters Kluwer/Provation Med
Women First Healthcare of WNY
Women's Wellness Associates
Wound Center of Niagara
WY Cnty DOH
WY Cnty DOMH
Wyoming count Nursing
Wyoming County Hospital
Xanitos
Xerox
Yasmin Pervez MD
Your Care Health Plan
Youth Link Towne Gardens
Zenith Medical
Zurich Insurance Company
--- Organization Not Listed ---
Please select a valid organization.
Organization Name
Remaining Characters: 25
Please check the organization list above to ensure that it does not already exist. If not in this list, the organization is currently not affiliated with Kaleida Health and is under review for approval.
What is your job title?
Please input a valid job title.
Select an Organization Approver
Organization Approver is a person who can validate you work for the Organization you are applying for access on behalf of.
Please select a valid organization and approver.
Approver First Name
Approver Already Exists in the list above, please choose this approver or provide a valid name.
Approver Last Name
Approver Already Exists in the list above, please choose this approver or provide a valid name.
Approver Phone
Please provide a valid phone number ###-###-####.
Approver Email
Please provide a valid email.
Previous
Next
Additional Details
Will you be working in a Kaleida Health Facility?
Yes
No
Please select a value.
What Kaleida Department are you working with?
Choose an department
Please select a valid department.
Location
--- Choose a Location ---
1260 Delaware Avenue
Amherst Adult Day Services
DeGraff Adult Day Care
Ambulatory Surgery Center
Buffalo General Medical Center
Children's Hospital
DeGraff Medical Park
Rehab & Pathology
Home Care-VNA Allegany County
Home Care-Chautauqua-Jamestown
Home Care-VNA Genesee County
Home Care-Niagara County
Home Care-Erie County(Wehrle)
Home Care-Warehouse
Herman Badillo School
Hertel-Elmwood Int Medical Ctr
1653 Kensington Avenue
Larkin Bldg @ Exchange Street
North Buffalo Medical Park
Millard Fillmore Suburban
Robert Warner Rehab Center
Invalid Location Entry
1010 Main Street
Home Care-VNA of Northwest PA
Home Care-Wyoming County
Nia Falls Mem Medical Center
Family Planning 1313 Main St
Home Care-Cattaraugus County
Home Care-Orleans County
1026-1028 Main Street
Home Care-VNA Livingston Co
Maple West
Kaleida Health Record Archive
Home Care-VNA Steuben County
Conventus
HighPointe
Southtowns Surgery Center
1100 Main Street
Franklinville
Occupational Health
Bradford Physician Offices
Bradford Dental Clinic
Bradford Regional Medical Cntr
Delevan Health Center
Limestone
Olean General Hospital
Upper Allegany Corporate Offic
Cuba Memorial
Brooks Memorial Hospital
Holiday Park
HSP Omega Physician Offices
Mount Jewett
North Barry
OGH Dialysis Dental Wound
Olean Med Arts Physician Off
Radiation Center
Olean OSC
Seneca Allegany Casino
Salamanca Health Center
Smethport
TLC
Broadway Pediatrics
--- Location Not Listed ---
Please select a valid location.
What do you need access to?
Eclipsys
Email
EMR
InfoClique
Remote Access
Other (specify in notes)
Please select a valid access type.
Access Required Date
Please select a valid date.
What is your End Date?
Please select a valid date.
Additional Notes
Previous
Submit
Submitting Request
Your request is being submitted, please wait.
Loading...
If you need assistance, please contact the Kaleida Health Technical Assistance Center at 716-859-7777.