1
Required Package

The Emergency Medical Services Learning Resources Center at University of Iowa Hospitals & Clinics requires the following package to be performed.

Background Check:Iowa Statewide Criminal Records
County Criminal Records (outside of IA, if applicable)
Nationwide Federal Criminal Records
Nationwide Sexual Offender Registry
US Patriot Act / OFAC
Healthcare Fraud & Abuse (OIG/GSA)
Social Security Validation
Residence History
Price:$29.00




 

 
  I have read, understand and agree to the Viewpoint Screening Disclaimer.
Applicant Information
Do not place an order on someone's behalf. This form must be filled out by the individual who requires Viewpoint Screening services.  
First Name*:  
Last Name*:
Middle Name:
Alias/Maiden Name 1:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 2:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 3:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Social Security Number*:
-
-

Please Note: If you have not been issued a valid U.S. SSN then enter all zeros (000-00-0000) instead.
Date of Birth*:
/
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(mm/dd/yyyy)
Gender*: Male        Female
Phone Number*: (111-111-1111)
E-Mail Address*:  IMPORTANT 
Your email address will be your user name to log in. Login names cannot be changed.

Please make sure you are entering your correct email address. You will be unable to log in or receive communications from Viewpoint Screening if your email address is not valid.


 
Type E-mail address.


Re-type E-mail address.

 If you already have an account: 
Please use the same email address associated with your current account to prevent separate logins.

Separate logins will contain separate results / medical documents, and cannot be combined.


 
Current Residential Address:
Address*:
City*:
State or U.S. Territory*:

For an international address, select "International" and select the foreign Country name below.
Country*:
Zip Code*:
ZIP Code Look Up Tool
Please Note: If you have an international address that does not require a Zip Code, please fill in "00000".

Please make sure you have provided correct information. Changes cannot be made once you have placed your order.
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