Kuwait University Center of Information Systems
Network Department
Please Read These Instructions!
1- Fill in the following fields
2- Print request form and get the appropriate approvals
3- Attach copy of your Mubarak Hospital ID and send it to information system department
DATE :
19-May-2024
Network Connection Request For Mubarak Hospital
To Filled By the User
* Name
First Name Midname Last Name
First Name is required
Last Name is required
Only Alphabetic Characters Allowed
Only Alphabetic Characters Allowed
Only Alphabetic Characters Allowed
* Civil ID.
Required Field
Only 12 Digit Number is Allowed
* Department
Administration
Anesthesia
Casualty
Laboratory
Medical
Nuclear Medicine
Nursing Department
OPD
Operation Theatre
Pediatric
Pharmacy
Physiotherapy
Preventive Medicine
Radiology
Surgical
Vascular Department
Requiered Field
* Building
Main Building
Amiree Extention
Hia Al-Habeeb
Mubarak Al-Jaber Dialysis Center
* Floor
Ground Floor
LG(Basement)
Mizaneen
Floor1
Floor2
Floor3
Floor4
Floor5
Tower1 - A1 Surgical-F1
Tower1 - A1 Surgical-F2
Tower1 - A1 Surgical-F3
Tower2 - A2 Dialysis-F1
Tower2 - A2 Dialysis-F2
Tower2 - A2 Dialysis-F3
Tower3 - A3 Peadiatrics-F1
Tower3 - A3 Peadiatrics-F2
Tower3 - A3 Peadiatrics-F3
Floor Is Required
Ward
Only 3 Digit Number is Allowed
* Room
Only 3 Digit Number is Allowed
Room is required
* Network Socket (Cable #)
B1
GF
MZ
F1
F2
F3
F4
F5
LG
C1
C2
C3
C4
C5
C6
C7
C8
C9
C10
C11
C12
C13
C14
C15
C16
C17
C18
C19
C20
IT
P1
P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
D
PS1
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
Socket is required
Socket Cabinet is Required
Field is Required
Field is Required
Socket Floor is Required
Email Address
* Telephone Number or Ext.
Phone extention is required
Only 8 numbers
Mobile No.
Only 12 numbers
Chairman Approval
Head Of Information Systems Approval
Hospital Director Approval
TSA Director (Signature & Stamp)
To Be Filled By Support Section (TSA)
IP Address
139.141.
Supnet Mask
255.255.255.
Gateway
139.141.
To Be Filled By Network Section (TSA)
Switch Name
Switch Port #
Vlan #