Ohleg Gateway Form PDF Details

The Ohleg Gateway Form is a web-based form that collects patient information for Ohleg Health. The form can be filled out by patients, doctors, or other medical professionals. The information collected by the form is used to create a patient profile on the Ohleg Health website. This profile allows patients to access their health information from any computer with internet access. The form is easy to use and takes only a few minutes to complete. It is important to fill out the form completely so that patients can receive the best possible care from Ohleg Health.

You will find details about the type of form you intend to fill out in the table. It can tell you the time you will require to fill out ohleg gateway form, what fields you will need to fill in and a few additional specific facts.

QuestionAnswer
Form NameOhleg Gateway Form
Form Length2 pages
Fillable?Yes
Fillable fields25
Avg. time to fill out5 min 34 sec
Other namesohleg call records, oh ohleg request, ohleg sign in, ohleg sf400 form

Form Preview Example

Instructions for applying for OHLEG access

To apply for access to OHLEG, please fill out the application form attached. To receive a quicker response to your request, please include an email address if available. After the form has been signed by your agency Chief, Sheriff, or designee, fax it to (740) 845-2021 or mail it to:

Ohio Law Enforcement Gateway

P.O. Box 365

London, OH 43140

Special Access Requests

Some applications within OHLEG require unique access privileges. If you are requesting access to one of the following applications, please attach a note to the application form noting which type of authorization you require (please choose only one per application).

MCCH - All law enforcement users with OHLEG access have “Case Operator” access, allowing them to view all cases in any agency. If you require additional authorization, please indicate the following:

MCCH Case User

Allows user to view, create, and modify their agency case information. They also have the ability to create posters, issue media and truckers advisories (email and fax notifications).

eSORN - All law enforcement users with OHLEG access have “Read” access. If you require additional authorization, please indicate one of the following:

eSORN Sheriff User

Allows user to view and create records in any agency and modify

 

records in their own agency

 

 

eSORN Sheriff Admin

Same as “Sheriff User” plus ability to update agency profile

eSORN DRC User

Allows user to view and create records in any agency and modify

 

records in their own agency

 

 

eSORN DRC Admin

Same as “DRC User” plus ability to update agency profile

Identity Theft Passport - All law enforcement users with OHLEG access have “Read” access. If you require additional authorization, please indicate the following:

Passport User

Allows user to view and create records in any agency and modify records in their own agency

Please contact the OHLEG HelpDesk with any questions regarding access.

Ohio Law Enforcement Gateway

PO Box 365

Londo n, OH 43140

Telephone: (866) 406-4534, or (866) 40-OHLEG

Facsimile: (740) 845-2021

www.ohleg.orgwww.ag.state.oh.us

OHLEG

Request for Access to Investigative Tools

Requestor Name

First:

Agency Address:

Email:

Date of Birth:

SSN:

Middle:

 

 

 

 

Last:

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

State: Ohio

Zip Code:

 

 

 

 

 

Non-Sworn:

 

 

Sworn:

-

 

 

 

-

 

 

 

 

 

 

 

If you have problems printing or viewing this form, please upgrade to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adobe Reader 7.0, or contact the OHLEG Helpdesk.

 

 

 

 

 

 

 

 

 

 

 

 

*Notification of activation will be sent via email. If email is unavailable, please note fax number: _____________________________

Requesting Agency:

ORI Number:

Agency Phone Number:

Terms and Conditions

The undersigned is hereby requesting user access to the investigative tools within the Ohio Law Enforcement Gateway (OHLEG) established by the Attorney General of the State of Ohio. Participation in OHLEG is voluntary. The undersigned agrees that all information from this site is for law enforcement purposes ONLY. Any dissemination to the public is strictly prohibited. The Social Security Number (SSN) is required and used solely for the purpose of maintaining user authentication. SSN’s will not be disclosed to individuals or agencies except in accordance with state and federal law, and policy of the Attorney General of the State of Ohio. Requests that are made without SSN or an authorizing signature will not be processed.

For Office Use Only

Director Approval: Date:

Entered By: Date:

Requestor’s Signature

Date

Chief / Sheriff or Designee Printed Name

Chief / Sheriff or Designee Signature

Date

O hio Law Enforcement G ateway

P.O. Box 365

Londo n, OH 43140

Telephone: (866) 406-4534, or (866) 40-OHLEG

Facsimile: (740) 845-2021

www.ohleg.orgwww.ag.state.oh.us

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