CareLink for all New Location Setup Process
Please select the market you are affiliated with
Please select your Location Type
Epic CareLink for all Location Signup Form
This process is specifically to request a new location to be setup to access Mercy Health’s Epic Carelink tool. The “Local Account Manager” provided in the form below will be the Account Access Manager and is expected to place new requests and manage accounts for their associates as referenced in this linked document Carelink Access Management. Even locations that will have a single user are required to have an Account Access Manager. Requests that are received for locations that have an Account Access Manager will be forwarded to that individual.
1. Download and sign this Security Agreement and save it to your computer.
2. Complete the fields below, next attach your signed security agreement and click Submit.

a.
Official Location Name
Office Address
b.
Street
c.
City
d.
State
e.
Zip
f.
Office Phone Number
g.
Office Email Address
h.
Any Physicians at your Location that have an affiliation with Mercy
i.
Mercy Hospitals or Locations that you have affiliations with
j.
Reason why you are requesting access for your location
k.
Amount of Staff that would require access at your facility
l.
Name of User acting as the “” (First Name, Middle Initial, and Last Name)
m.
Local Account Manager Email Address
n.
Local Account Manager Phone Number
o.
Local Account Manager Job Title
p.
Last four of Applicant's Social Security Number
Attach your signed security agreement from step 1.