I am requesting access to FNEHR IT System(s) to obtain Electronic Health Records,
and agree to the following terms and conditions:
Clinic means a physician, practitioner, a health care provider, a group practice,
partnership, or corporation of physicians and/or practitioners, health care providers
and its employees.
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 FNEHR internal operations.
Electronic Health Record ("EHR") means a repository of consumer health status information
in computer processable form used for clinical diagnosis and treatment for a broad
array of clinical conditions. EHRs contain Protected Health Information.
Information Technology ("IT") for purposes of obtaining access to FNEHR 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 Clinic 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 to an individual, or the past, present,
or future payment for the provision of health care 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 Hospital
from or on behalf of Clinic, or is created by Hospital, or is made accessible to
Hospital by Clinic. 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 FNEHR 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, but not limited
to, 45 C.F.R. Sections 160.103 and 164.501; 42 C.F.R. Chapter IV, Section 411.351,
and 411.357, and 42 C.F.R. Section 1001.952.
I acknowledge that Hospital IT system is the property of FNEHR. I agree to use Hospital
IT system solely for job-related purposes.
I understand that all EHR available through Hospital IT system is confidential and
is to be treated as such.
I agree to access Hospital IT system only in the minimal amount necessary to obtain
EHR for the provision of health care services to the Clinic patient(s).
I understand that passwords and user identification ("ID") are utilized to access
Hospital 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 FNEHR Security Officer (800-923-4258) so
that appropriate action may be taken.
I understand that I am not permitted to access the Hospital IT systems for anything
other than my intended job-related purpose relating to patient treatment, payment
or Hospital operations. Accordingly, I understand that I am not permitted access
to my or another individual's health information because of a personal request,
personal reasons or personal curiosity. I acknowledge that unauthorized access of
EHR, confidential files, or Hospital IT system without the proper security clearance
and/or access authorization, is for whatever reason, considered a violation of the
Access to Electronic Health Records Policy.
I understand that the Hospital IT systems are monitored by FNEHR Information Technology
Department. I understand that IT security features, such as passwords and message
deletion functions, do not remove the ability to archive messages, at any time,
for future auditing. I understand that the Hospital IT system is subject to search,
and that FNEHR is able to track and monitor my access into Hospital IT system. I
understand that I do not have any personal privacy rights by utilizing Hospital
I agree that I will use FNEHR IT system only to access EHR for patient care purposes.
I promise that I will not use Hospital IT system for any other purpose including
personal use, solicitation for outside business ventures, campaigns, and political
or religious causes. I understand that I am prohibited from storing, displaying,
or disseminating obscene, offensive, harassing, or discriminatory textual or graphical
materials on Hospital IT systems.
I have read the Policy on Access to Electronic Health Records ("EHR Policy") and
agree to be bound by the terms and conditions of the EHR Policy. I understand that
should I, or my employee, violate any provision of the EHR Policy, FNEHR will discontinue
my access to Hospital IT system(s). Additionally, FNEHR may take legal action against
me, including seeking monetary damages for inappropriate use and/or disclosure of
I agree to indemnify, defend and hold harmless, Hospital and its affiliates, and
their respective members, trustees, officers, directors, employees and agents, from
and against any claim, cause of action, liability, damage, cost or expense, including
without limitation, reasonable attorneys fees and costs, arising out of or in connection
with any unauthorized or prohibited Use or Disclosure of Hospital IT system, PHI,
or any other breach of the EHR Policy by myself or my employee.
I acknowledge that I have read, understand, and agree with the conditions above.
Further, I agree to immediately notify FNEHR of any conflict with or violation of
the above conditions.