Request New User Kaiser New User Form Requester InformationPlease complete the following section with your information.Name First Last Location*Department*Email* Phone*New User InformationPlease complete the following section with the information of the new user you are requesting.Name* First Last Location*KPBSunnysideWestsideDepartment*Case ManagementCC SpecialistCertified Medical AssistantFinancial CounselorManagerSocial WorkAmbulatory Surgical CenterEmail* Phone*Has this user been trained using the C3CAP TrackVia training materials?It is the responsibility of the Super User submitting a New User request to ensure that the new user has been properly trained on C3CAP's TrackVia system. Please visit https://www.c3cap.org/kaiser/support/ to find links to the TrackVia training materials.YesNoWill this user be a Super User?*A Super User is a designated TrackVia user who is available for mentoring, troubleshooting, training, testing new features and making Special Requests for their department, including supply requests, as well as requesting new users and new vendors. YesNo