IDXrad Access Request by xit16869

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									                Hackensack University Medical Center
               PACS & WEB1000 ACCESS REQUEST

        Add User

    Delete User

Last Name:                           First Name:
Department/Office:                   Last 4 Digits of SS#:
Address:                             Phone Number:

    Classification:
   Clinician
   Resident
   Student Technologist
   Film Librarian
   Technologist
   Scheduler/ Receptionist
   Supervisor
   Section Chief
   Departmental Nurse
   Radiologist

Date Requested:


Requested By: _________________ Approved By: ________________


Completed By:

Date:

Comments:


                   Please fax completed form to 201-487-4909.
                           HACKENSACK UNIVERSITY MEDICAL CENTER
                            USER CODE OF CONDUCT FOR COMPUTER SYSTEMS

         For the purpose of this document “User” means all authorized Users of Hackensack University Medical
Center’s computer system. This may include employees, staff physicians, residents, volunteers, independent
contractors, consultants, and other authorized personnel.

         Computer systems and the information they contain, control, transmit or process are essential for HUMC’s
daily operations. They help provide services to patients,
maintain vital records, collect revenues, and process information necessary for internal operations and development.

         Users are responsible for ensuring that computer systems and the information
they contain are adequately safeguarded against damage, alternation, theft, fraudulent manipulation, and unauthorized
access or disclosure. Though the data processed and stored in a computer may appear to be intangible, it must still be
protected as a Medical Center asset, and properly identified and safeguarded according to its proprietary
and/or critical nature. Passwords or other procedures used to access or transmit computerized data must be selected,
controlled and safeguarded to ensure that
Medical Center data is adequately protected. Ultimately, each User is responsible for
the security of information accessed or modified under his/her password or access procedure. Also, as User or manager
of Medical Center data or computer resources,
each must strictly adhere to the specific security measures and controls that have been established.

         Along with the responsibility for safeguarding the information in Medical Center databases, Users are
responsible for:

                  Obeying U.S. copyright laws and Medical Center policy regarding the reproduction of copyrighted
                   software.

                  Using licensed computer software only as permitted by the specific license.

       Any personal, non-business use of a Medical Center data communication system
of computer system (mainframe, micro, mini, or personal computer) or access and
disclosure of information contained therein that is not specifically authorized by
supervision is forbidden.

      Violations or suspected violations of computer security measures or control should
be reported to your supervisor immediately.

      Violation of this policy will result in disciplinary action up to and including
termination.


             See next page for HUMC’s User Code of Conduct for Computer Systems




                           HACKENSACK UNIVERSITY MEDICAL CENTER


                        Please fax completed form to 201-487-4909.
                COMPUTER SYSTEM CONFIDENTIALITY AGREEMENT


I acknowledge that I have read, understand and will abide by Hackensack
University Medical Center’s User Code of Conduct for Computer System.
(Copy on Reverse).

I understand that the transactions made using my User-ID and password will be
“electronically stamped” with my “electronic signature”.
To this end, I am responsible for protecting my electronic signature.

I further understand that as a condition of my access to the computer system I agree to
the following:

             I will commit my User-ID and password to memory and not
              write them down anywhere.

             I will not divulge or share my password

             I will change my password if there is any possibility that it
              may have been compromised.


I understand that any violation of the confidentiality of the system information can result in
disciplinary action, including dismissal – even for a first offense in appropriate
circumstances and criminal prosecution.




        PRINT NAME                                SIGNATURE                         DATE




                  Please fax completed form to 201-487-4909.

								
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