{"text_format":"1","workbook":"xlsx","n_sheets":4,"sheets":["1) Intake Data","2) BlueFin Information","Sheet3","3) Reference Information"],"not_rendered":{"charts":0,"images":5,"macros":1,"external_links":0,"defined_names":1,"comments":1,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"1) Intake Data","index":0,"n_rows":34,"n_cols":29,"rows_kept":34,"cut":false,"hidden":false,"merged":[[33,1,33,12],[9,8,9,9],[11,8,11,9],[13,8,13,9],[15,8,15,9],[17,8,17,9],[28,1,28,12],[30,2,30,9],[23,8,23,9],[21,1,21,5],[19,8,19,9],[21,8,21,9],[23,2,25,4],[1,1,1,12],[3,1,3,12],[5,1,5,5],[5,7,5,12],[7,8,7,9]]}
[]
[null,"BLUEFIN DEVICE ORDER INTAKE FORM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Standard",null,"PAX A80",null,"Devices for New Credit Card Location",null,"Yes"]
[null,"Instructions:  Please populate the shaded fields below and all applicable fields in the Bluefin Information tab.  Once completed, please attach and e-mail to the Enterprise Information Security PCI Office mailbox at pci_office@optum.com.\nImportant: In order to activate and manage your device, please submit a UHG Secure request for access to the Bluefin P2PE Manager and select the appropriate role (see UHG Bluefin Microsite at for a description of roles and frequeuntly asked questions). ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Expedited",null,"PAX A920",null,"Devices for Existing Credit Card Location ",null,"No"]
[]
[null,"Section 1: Requestor Information ",null,null,null,null,null,"Section 2: Device Information\nNote: $35 Injection Fee Per Device",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"A920 Stand"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"7' Ethernet Cord",null,"Stand Alone"]
[null,null,"Date (MM/DD/YYYY):",null,null,null,null,null,"Point of Sale Device: (Select from dropdown)         Note: 4 ft Ethernet Cable Included with each device",null,null,"PAX A80",null,null,null,null,null,null,null,null,null,null,null,null,"10' Ethernet Cord",null,"Semi Integrated with EPIC"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"None",null,"Unsure (contact pci_office@optum.com)"]
[null,null,"Requestor Name:",null,null,null,null,null,"Total Keypad Quantity: (Please verify this amount ties with  total devices to be shipped in tab 2, column H)"]
[]
[null,null,"Requestors Phone Number:",null,null,null,null,null,"Device Configuration: (Select from dropdown)",null,null,"Stand Alone"]
[]
[null,null,"Requestors E-Mail Address:",null,null,null,null,null,"Optional Accessories: (Select from dropdown)",null,null,"None"]
[]
[null,null,"Requestors Mail Route:",null,null,null,null,null,"Optional Accessories Quantity:"]
[]
[null,null,"Requestors Business Name\n(UHG Legal Entity Name)",null,null,null,null,null,"GL String for Charges - Keypad:\n(BU-OU-Locn-Dept)"]
[]
[null,null,null,null,null,null,null,null,"GL String for Charges - Monthly Recurring Charges:\n(BU-OU-Locn-Dept)"]
[]
[null,"Section 3: Comments\n(Please include any additional comments/information needed for the order)",null,null,null,null,null,null,"Shipping Account Number: (UPS, FEDEX, ect.)"]
[]
[null,null,null,null,null,null,null,null,"Location Type for Device: (Select from dropdown)",null,null,"Devices for New Credit Card Location"]
[]
[]
[]
[]
[null,"Section 4: Acknowledgement of Requestor (Mandatory)"]
[]
[null,null,"I am confirming that the assigned PCI Business Relationship Manager is aware of this site and the individuals taking credit card payments.  The PCI Business Relationship Manager has ensured proper training, call muting and Data Flow Diagram documentation is in place in accordance with PCI Compliance requirements.  Select from dropdown.  If No is selected a PCI Business Relationship Manager will reach out to you to discuss further.",null,null,null,null,null,null,null,null,"Yes"]
[]
[]
[null,"Next: Please Continue to Bluefin Information tab to provide Bluefin device shipping details and P2PE Manager, Merchant Information"]

{"sheet":"2) BlueFin Information","index":1,"n_rows":324,"n_cols":25,"rows_kept":324,"cut":false,"hidden":false,"merged":[[3,1,3,9],[3,19,3,24],[3,11,3,17],[1,11,1,17],[1,19,1,24],[1,1,1,9]]}
[]
[null,"Section 1: BLUEFIN DEVICE COUNT and SHIPPING INFORMATION",null,null,null,null,null,null,null,null,null,"Section 2: BlueFin P2PE MANAGER ACCES",null,null,null,null,null,null,null,"Section 3: Merchant Information "]
[null,"Line #","Ship To Contact Name","Phone Number","E-mail Address","Business/Clinic Name","Full Shipping Address","Number of Devices to Ship to Address","Shipping Preference:   Standard/Ground, Priority/2 Day, Expedited/Overnight, Expedited/Saturday?  Please see shipping price estimates and timelines in reference tab","Comments",null,"Device Custodian Name","Device Custodian MS ID\n(Provide Primary MS ID)\n*For Non-Integrated Entities Requiring MS IDs: \nUse the link below to complete the UHG Access Request Form. Business Reason = \"Blufin P2PE Manager set up\". This will be the onset of the on-boarding process to Contractors Express and will generate an employee ID and MSID.","Device Custodian Phone Number","Device Custodian E-mail Address","P2PE Manager Partner\n(Please provide NEW or Existing P2PE Manager Partner / Business Entity Name)","P2PE Manager Role\n\nPartner Fullfillment - Conduct device attestations for all clients or locations and ability to manage devices; shipments and run reports.\n\nPartner Supervisor - Elevated access to transfer devices, partners, clients.   (Restricted to Area Mgrs, PCI Office, Treasury). \n","Comments",null,"PNS #\nSourced from VAR sheet (12 digits)","Visa/MC MID # \nSourced from VAR sheet (7 digits)","Client Code\nSourced from VAR (4 digits)","TID\nSourced from VAR sheet (3 digits)","NetConnect Username\nContact your Teasury Consultant if needed","NetConnect Password\nContact your Teasury Consultant if needed"]
[null,null,null,null,null,null,null,null,null,null,null,"Important: To activate and manage your device, please submit a UHG Secure request for access to Bluefin P2PE Manager. Note: A custodian is the person who takes responsibility for device compliance and not necessarily the primary person interacting with the device. Questions? Contact PCIoffice@optum.com",null,null,null,null,null,null,null,"If new Chase Paymentech Merchant ID(s) are needed, or if you already have a Merchant ID but require VAR sheet details to complete the below fields, please contact your Treasury Consultant or the TSG@UHC.com mailbox"]
[null,"0 (Sample)","Steven Sample","123-456-7891","ssample@test.com","Acme Radiology","ATTN: Steven Sample, Acme Radiology 100 Main St. Anytown, TX 12345",5,"Standard",null,null,"Steven Sample","ssample01","123-456-7891","ssample@test.com",null,"Client Custodian",null,null,119599991111,6551234,9719,"001","MC123456","ABC123"]
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{"sheet":"Sheet3","index":2,"n_rows":10,"n_cols":8,"rows_kept":10,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,"Standard",null,"PAX A80",null,"Devices for New Credit Card Location",null,"Yes"]
[null,"Expedited",null,"PAX A920",null,"Devices for Existing Credit Card Location ",null,"No"]
[]
[null,null,null,"A80 Stand",null,"Stand Alone"]
[null,null,null,"A920 Stand",null,"Semi Integrated with EPIC"]
[null,null,null,"7' Ethernet Cord"]
[null,null,null,"10' Ethernet Cord"]
[null,null,null,"None"]

{"sheet":"3) Reference Information","index":3,"n_rows":51,"n_cols":5,"rows_kept":51,"cut":false,"hidden":false,"merged":[[3,1,3,4],[15,1,15,4],[1,1,1,4]]}
[]
[]
[]
[null,"DBA Descriptions"]
[null,"Field","Length","Description","Additional Comments"]
[null,"DBA Name",22,"\"Doing business as\"/Store name of the location (ex: ACME # 1001)","Can be up to 22 Characters long and can contain Alpha numeric characters "]
[null,"DBA Address",27,"The store's physical address","Can be up to 27 Characters long and can contain Alpha numeric characters"]
[null,"DBA City",20,"The store's city","Can be up to 20 characters long "]
[null,"DBA State",2,"The store's state","Must be 2 characters long and only contain Alpha characters"]
[null,"DBA Zip Code",5,"The store's zip code","Can be 5 digits long and CANNOT contain spaces, dashes, or parentheses"]
[null,"DBA Phone",10,"The store's phone number","Must be 10 digits long and CANNOT contain spaces, dashes, or parentheses. Customer Facing Number.  Please make sure no personal numbers are used."]
[null,"DBA Fax",10,"The store's fax number, if one exists","Can be 10 digits long and CANNOT contain spaces, dashes, or parentheses"]
[null,"DBA Contact",30,"The store manager's name","\"Manager\" can be entered here if no name is provided. If a name is provided,  first and last name can be up to 15 characters each"]
[null,"DBA Contact Email",50,"The store's email address, if each store has one. If not, corporate email address would be the default","Can be up to 50 characters long including any special characters and the ampersand"]
[]
[null,"P2PE Manager Roles"]
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[null,"Shipment Type","Shipment method","Notes","Cost (pricing may vary depending on shipper/rate changes)"]
[null,"Expedited","P2PE SHIP-OVNGHT 1-2 devices","If more than 2 devices - Quote needed from Key Injection Facility",60]
[null,"Expedited","P2PE SHIP-SATURDAY DEL 1-2 devices","If more than 2 devices - Quote needed from Key Injection Facility",60]
[null,"Expedited","P2PE SHIP-PRIORITY OVERNIGHT 1-2 devices","If more than 2 devices - Quote needed from Key Injection Facility",60]
[]
[null,"Priority","P2PE SHIP-2DAY-1-9 Devices",null,25]
[null,"Priority","P2PE SHIP-2DAY-10-19 Devices",null,30]
[null,"Priority","P2PE SHIP-2DAY-20-29 Devices",null,33.5]
[null,"Priority","P2PE SHIP-2DAY-30-40 Devices",null,37]
[]
[null,"Standard","P2PE SHIP-GRD-1-9 Devices",null,25]
[null,"Standard","P2PE SHIP-GRD-10-19 Devices",null,30]
[null,"Standard","P2PE SHIP-GRD-20-29 Devices",null,33.5]
[null,"Standard","P2PE SHIP-GRD-30-40 Devices",null,37]