Zoom for Healthcare Accounts Request Form

1. Purpose

Zoom for Virtual Health Visits accounts are provided only for conducting or supporting clinical Virtual Health Visits. Such an account is not necessary to join virtual health visits or any other Zoom meetings.

To request a Zoom for Virtual Health Visits account for conducting or supporting virtual health visits, please complete the fields below. If you have any questions, please visit the Office of Virtual Health Zoom for Healthcare webpage or email OVHZoomSupport@phsa.ca.

2. Requestor Information

Fields with a * are mandatory

* Health Organization: If you are a private practice physician, please select Private Practice.

* First Name:

* Last Name:

* Program/Clinic: A health organization must be selected first.

* Department: A health organization must be selected first.

* Role: A health organization must be selected first.

* Phone Number:

Extension:

* Business Email:

* Re-enter your business email:

Are you requesting a Zoom for Virtual Health Visits account for yourself?

Note: After clicking the checkmark, any further changes made in Section 2 above will not be reflected in Section 4.

To refresh and update your data in Section 4, uncheck and recheck the box.

3. Training

* I will ensure the individuals that I am applying a Zoom account for in this group application form are aware of the associated educational resources:

Zoom Online Training - Learning Hub Course

Read the TOU - Community Living BC

Healthlink BC

Provincial Health Services Authority

Providence Healthcare

Island Health

Doctors of BC

4. Individuals who require a Zoom for Virtual Health Visits account

Note: Only the first row is mandatory and must be filled out before submitting a request. Location/Region (if available) must be selected.

A Health Authority email address is mandatory for all Health Authority providers and staff.

At present, you can only request Zoom accounts for individuals belonging to the same Health Authority as you.

	First Name	Last Name	Health Organization	Department	Program/Clinic	Role	Location	City	College ID	Business Email Address	Clear
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5. Comments

#	Health Organization	Instructions/Links
1	VCH	If you require a Vancouver Coastal Health Zoom for Healthcare account, please complete the VCH Zoom Request Form.
2	FNHA	If you want to use Zoom for clinical use, please contact the FNHA eHealth Service Desk at ehealthsupport@fnha.ca
3	FHA	If you want to use Zoom for clinical use at Fraser Health, you must fill out the Zoom request form to be compliant under Canadian privacy laws.
4	Interior Health Authority	If you require an Interior Health Zoom for Healthcare account, please submit a request to Interior Health Zoom team at zoom@interiorhealth.ca
5	Northern Health Authority	Northern Health employees are requested to contact ITS Service Desk at servicedesk@northernhealth.ca for direction on NHA Zoom inquiries

1. Purpose

2. Requestor Information

3. Training

4. Individuals who require a Zoom for Virtual Health Visits account

5. Comments

1. Purpose

2. Requestor Information

3. Purpose of recording virtual health doctor visits?

4. Detailed description of your use case

5. Terms of use

6. Supervisor approval

7. Training