New Staff Member Activation Form Must be filled by a doctor or office manager.Staff InformationNameFirst(Required) Middle(Required) Last(Required) Office* (if more than one)(Required) Email(Required) PhoneTitle/Role(Required) Doctor/Provider Tech Front Desk Optical Other Foxfire PM & EHR Permissions: Indicate whether the above staff should have the following abilities. FOXFIRE PM Finalize Process Claims Process Month End Process Year End Process Analysis Reports Send Statements Manage Statement Parameters View Product Pickup Send Charges To CCB Manage Dashboard Settings Manage Web Schedule Allow user to be Assigned To An Order Manage Scheduling Operators Manage OpenEdge Settings Can Update Staff On Orders FOXFIRE EHR Merge Patients Manage E-Rx Un-Sign Charts Delete Diagnostic Tests & Documents Access to Order follow up and Charges not sent to PM Should receipts and payments print automatically? Yes No To what printer?(Required) Must be signed by a doctor or office managerName(Required) First Last Signature(Required)