Name of User: ___________________________________ Date: ____/____/____
Department: ________________________________ Ext. ________________
(Clinic Name) will provide to clinical staff members and other employees whose job description requires, a computer by which to access and document patient health information and other clinic related electronic information. This computer is the sole property of (Clinic Name) and is to be used only for (Clinic Name) business purposes and the following provisions must be agreed to prior to assignment of computer workstations.
(Clinic Name) will provide: 1. A functioning computer with appropriate access to network drives and software applications necessary for the above named employee to do their assigned job(s). 2. Technical Support for the computer and supporting network and any clinic approved hardware residing upon it i.e. scanner, printer etc. 3. Training necessary to function on the assigned hardware and software applications provided to the employee. 4. A secure network and secure logins and passwords for adherence to HIPAA Privacy and Security standards. 5. Firewall monitoring, Virus Protection and Software Access audit trials
The Employee (User) will adhere to the following: 1. The computer will remain on the property of (Clinic Name) at all times and will not be removed from the premises without prior approval from Information Systems and their manager. 2. Logins and passwords are never to be shared. Actions taken on a login will be the responsibility of the assigned user. If there are any suspicions that another may be using their login/password report this immediately to Information Systems for password reset. 3. Patient Information is to be safeguarded, log off or close computer monitor on portable devices when leaving workstation. All data viewed, entered or altered can be tracked by an audit trail, protect yourself and your patient information – log off when not in use. 4. Assigned computer can be shared or used by other clinic personnel but should not leave its assigned area. Non-clinic personnel should never have access to (Clinic Name) computers, and all safe efforts should be made to prevent non-clinic persons from accessing computers. 5. Software which is not supplied or approved by (Clinic Name) Information Systems will not be loaded onto this computer. Any software applications loaded without Information Systems endorsement will be removed immediately. 6. Personal data/programs/pictures etc. should not be put on computers that are the property of (Clinic Name). 7. Computers supplied to the employee will be securely locked on a nightly basis, or when not in use, and placed on the charger in readiness for the next days business. A portable computer cable combination lock will be supplied by the clinic and secured to the desk. Random checks to assure compliance will be done by Information Systems and EMR staff. 8. At the end of the workday the computer should be securely shut down, by going to the Start menu, and selecting shut down or log off. 9. Charging the portable computer is the users’ responsibility, a docking station will be provided for charging as well as replacement batteries. Changing out the battery and making sure the depleted battery is on the charger is the users responsibility. 10. Internet access should be limited to clinic business needs. And the following restrictions must be followed: a. Access to personal e-mail should be limited and not interfere with job performance. b. Never open e-mail from an unknown sender and never open unknown or suspicious attachments. c. Downloading Internet games or programs, music, videos, etc. are prohibited. d. Abuse of Internet access may result in removal of Internet privileges. 11. (Clinic Name) e-mail accounts is to be used for Clinic business and may be monitored and audited by the Clinic. Personal e-mails should be addressed to other Internet e-mail accounts (yahoo, hotmail, AOL etc.) and other e-mail advisements noted above should be followed.
I agree to the above provisions and accept the assignment of Computer SN#________________. I am aware that any violations to the above provisions could result in disciplinary action including dismissal.
Signed: ________________________________________ Date: _________________________