Policy Manual sample

MDT Home Health Care Agency, Inc. EXHIBIT B - User and Confidentiality Access Agreement ELECTRONIC HEALTH RECORD USER AND CONFIDENTIALITY ACCESS AGREEMENT WITH AGENCY HEALTH/MEDICAL RECORD SYSTEM This Agreement must be completed and signed by each individual requesting access to Agency Health System’s (EHS) Electronic Health Records. The Agreement must be completed and returned to the EHS Administrator before access will be granted. Name of individual requesting access (please print): _______________________________________ Staff Name: _________________________________________________________________________ Please Print Name of Authorizing Staff: _________________________________________________ I am requesting access to EHS IT System(s) to obtain Electronic Health Records, and agree to the following terms and conditions: Staff means a Registered Nurse, Licensed Practical Nurse, Registered Therapists (Physical, Occupational, Speech, Respiratory), Therapists Assistant (Physical, Occupational, Speech), Home Health Aide/Certified Nursing Assistant or office staff (all clerical, officials of the Agency). Disclose and Disclosure mean, with respect to Protected Health Information, the release, transfer, provision of, access to, or divulging in any other manner of Protected Health Information outside EHS internal operations. Electronic Health Record (“EHR”) means a repository of consumer health status information in computer processable form used for Staffal diagnosis and treatment for a broad array of Staffal conditions. EHRs contain Protected Health Information. Information Technology (“IT”) for purposes of obtaining access to EHS EHR includes by way of example: rights, licenses, and intellectual property related to the EHR software; connectivity services, including broadband and wireless internet services; portals; secure messaging capabilities and related services that are used in the automatic acquisition, storage, manipulation, management, movement, control, display, switching, interchange, or transmission or reception of data or information in any electronic medium to any source. IT for purposes of EHR does not include hardware, including routers or modems necessary to access or enhance connectivity, and operating software that makes the hardware function; storage devices; software with core functionality other than EHR (such as human resources or payroll software or software packages for practice management or billing); or items used to conduct personal business or business unrelated to Staff practice. Protected Health Information (“PHI”) means information, including demographic information, that (i) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care/data entry to an individual, or the past, present, or future payment for the provision of health care/data entry to an individual; (ii) identifies the individual (or for which there is a reasonable basis for believing that the information can be used to identify the individual); and (iii) is received by Agency from or on behalf of Staff, or is created by Agency, or is made accessible to Agency by Staff. PHI may be contained in other mediums including without limitation, electronic PHI, EHR, paper records, audio, and video recording. Use or Uses means, with respect to PHI, the sharing, employment, application, utilization, examination or analysis of such PHI within EHS’ internal operations. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the Privacy and Security Regulations including. I acknowledge that Agency IT system is the property of EHS. I agree to use Agency IT system solely for job-related purposes. I understand that all EHR available through Agency IT system is confidential and is to be treated as such. I agree to access Agency IT system only in the minimal amount necessary to obtain EHR for the provision of health care/data entry services to the Agency patient(s). I understand that passwords and user identification (“ID”) are utilized to access Agency IT system. I acknowledge that I may not divulge my password or ID to any other individual or entity. I understand that I am responsible for any damages, including monetary damages, for the inappropriate use and/or disclosure of PHI, even if such inappropriate use and/or disclosure was made by another individual using my password or ID. I agree that if I suspect that my password or ID has been obtained by another individual, I will immediately change the password for the account and inform EHS’ Administrator so that appropriate action may be taken. I understand that I am not permitted to access the Agency IT systems for anything other than my intended job- Home Health Agency Policies A-176