Epic Cash Drawer Add/Change/Delete Request Form

Use this form to submit a request to create a new Epic Cash Drawer (CDW) or update an existing Epic Cash Drawer. Submission of this form will automatically create an IS Service Request and be routed to the proper IS resources.

Your request will be completed within two weeks of receipt.

DO NOT include any Protected Health Information (PHI) on this form.

By checking this box, I am verifying that I am an Authorized Requestor in a manager/director role or a designated authorized requestor. *

Confirmed

Requestor name: *

Requestor position: *

Requestor email: *

Requestor phone number: *

Is this request to add a new drawer, change an existing drawer, or delete an existing drawer? *

Name of employee to be given Cash Drawer: *

ID of employee to be given Cash Drawer: *

Beginning balance: *

Employee to add to current drawer:

Employee ID to add to current drawer:

Employee’s Service Area: *

Employee’s Supervisor: *

Employee’s Training Date (optional): +

Service area change:

Supervisor change:

Cash Drawer/Employee to be deleted: *

Service area: *