Enroll in VIP as a medical certifier
Contact for Enroll in VIP as a medical certifier
Registry of Vital Records and Statistics - V.I.P. Project Team
The Details of Enroll in VIP as a medical certifier
What you need for Enroll in VIP as a medical certifier
The certifier must:
- Sign a Virtual Gateway Services Agreement
- Identify the Access Administrators by filling out then signing an Access Administrator Designation Form
- Sign a VIP User Confidentiality Form
- Mail the original copies to the RVRS
The certifier or another Access Administrator will then submit a VIP User Request Form by email; listing all users including those for data entry.
If there are other personal office staff that will require access to the VIP system. They will only need to submit additional VIP User Confidentiality Form for office staff in a small medical practice, if that person will enter death certificate information for your certification.
Each physician in a small medical practice should submit additional VIP User Confidentiality Form for those who can enter death record information for their patients. Hospital and other larger facility staff will obtain accounts through those organizations.
How to enroll Enroll in VIP as a medical certifier
The forms required to enroll and important facts about them:
- Virtual Gateway Services Agreement (VGSA) Use your address as submitted to the Board of Registration in Medicine and use your medical license number instead of Tax ID #. You can also use the address of the primary hospital or medical facility that you work for. We would advise against using your home address on this form.
- Access Administrator Designation Form (AA) This form requires a minimum of 3 signatures to be accepted as complete by the Virtual Gateway and is the most commonly rejected form due to missing signatures please review prior to submission.
- VIP User Confidentiality Form (UA) We will accept this form submitted in any manner as long as it has been signed by the user
- VIP User Request Form (URF) This document should be filled out electronically and submitted by email as an attachment in Microsoft excel format only. We cannot accept this form submitted in any other manner and it must be submitted by one of the people listed as an Access Administrator on the Access Administrator Designation Form (AA)
We require that you print out, sign, and mail the first 3 agreements. Once thoroughly reviewed and signed, mail the originally signed forms to the following address. Copies of signatures are not accepted.
Word document versions of these forms are available in the downloads below.
Registry of Vital Records and Statistics
ATTN: VIP Enrollment Team
150 Mt. Vernon Street, 1st Floor
Dorchester, MA 02125-3105
If you have any questions, please contact the VIP project team via email: VIP-Accounts@state.ma.us
More info about Enroll in VIP as a medical certifier
Just a reminder: the information collected through the VIP system is highly sensitive; therefore, it is imperative for the appropriate users to sign the legal agreements in order to gain access to the VIP system. User accounts will be created for each user name provided to access the VIP system, once the Registry has received all the signed agreements. User account processing takes up to 10 business days.
A brief purpose of each agreement follows:
- The services agreement defines the terms that apply to the organization’s access to the Virtual Gateway services. The signatory level authority at your organization should read and sign the Services Agreement. In the case of medical certifiers the certifier should be the signatory and use his/her own name and title as the name of the Organization/Entity
- The access administrator designation agreement identifies the access administrator as well as the backup access administrator. This agreement describes the responsibilities of the access administrator role such as submitting requests for user account creation, submitting requests for user deactivation, and reporting suspected fraud of the VIP system. Our recommendation for the Access Administrator is someone who is in a supervisory role within your organization. This agreement will need to be reviewed and signed by the signatory level authority as well as the named access administrators. This form requires a minimum of 3 signatures and a maximum of 5 signatures to be considered complete. The number of signatures required depends on the number of Access Administrators listed.
- The RVRS user agreement describes the terms and conditions for use of the VIP system. Each user will identify their functional role and agree to the terms and conditions stated on this agreement. Each individual associated with the VIP system will be required to read and sign the agreement including the access administrators.
- The user request form will need to be completed electronically by the access administrator with the details of each user of the VIP system in your organization and this form should be provided via email. This information is required to generate the VIP and VG user accounts. This form will be used in the future when submitting a new request for a VIP user account.