Karmanos OmniCell User Request Form | Karmanos Documents and Links

*Indicates required information

First Name: *

Last Name: *

Your location - unit: *

First name of new staff member: *

Last name of new staff member: *

Their start date: *

Their employment status: *

Karmanos - DMC Employee

Agency RN

If Karmanos-DMC Employee:

Please provide their employee ID (Employee ID = PeopleSoft ID; For Agency Nurses, use Citrix user ID): *

Please provide their DMC-Citrix User ID (MUST provide Citrix user ID to process request): *

If Karmanos-DMC Employee, please select their position: *

If Agency RN:

Please select their contract end date:

Comments:

Captcha*