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Meditech Access Request Form for Non-Affinity Staff

This online policy and Meditech request form can be submitted by those Physician offices affiliated with Affinity Health System wishing to gain access to the Meditech HCIS system.

PLEDGE OF CONFIDENTIALITY  

As employees of the health care industry, we must adhere to a strict code of ethics and privacy.  Our patients and co-workers depend upon us to safeguard their right to privacy and keep all acquired information confidential.  

It is absolutely necessary to keep any and all patient and business-related information which is told to you, seen by you, acquired by you, or heard by you strictly confidential.  This includes, but is not limited to, any patient information such as diagnosis, treatment, reason for visit or condition of a patient; employee information, payroll and personal information; the billing and accounts receivable system; the general ledger; or, any other data considered to be privileged and confidential by Affinity Health System.  In addition, you agree not to seek out information regarding a patient which your job does not require you to obtain.   

Failure to observe this policy will result in disciplinary action, and could result in your being held personally liable in a court action by a co-worker, a patient or their family.

I, the undersigned, acknowledge that I have read the above mentioned statement and will keep confidential any and all information acquired.  I further agree to hold harmless and protect Affinity Health System against any and all claims for damages resulting from any unauthorized disclosure of such information.  

USER RESPONSIBILITES  

Only authorized personnel shall have access to patient information as required for the performance of their job duties.  Access for any other reason is not permitted.  Users shall not access, divulge, discuss, or in any manner use information related to themselves or another patient beyond that necessary for the performance of the user’s job duties.  Authorization to access information is assigned on a need-to-know basis, and access of all users is tracked electronically and/or manually.  The privileges granted to all users will be periodically reviewed by the Information Systems Department.  Failure to maintain appropriate confidentiality is prohibited conduct, and is subject to disciplinary action.   

Each user is personally responsible for the usage of his or her user-Id and password.  Dormant user-Ids which have not seen any activity for a period of time, typically 90 days, will have their privileges automatically revoked.  Users must not share a password with anyone, including their manager or co-workers.  Passwords must not be written down in some readily-decipherable form and left in a place where unauthorized persons might discover them.  If a password is compromised, the user is responsible to call the AHS Information Systems Department immediately to have the password reset.  

Questions about the appropriate handling of a specific type of information or use of user Id and password should be directed to either the manager or the AHS Information Systems Department.  

In fulfilling its obligations, all responsible persons commit, without limitation, to the following:

  • Responsible person will review the above Pledge of Confidentiality and User Responsibilities with user.    
  • Responsible person will transfer new login names and passwords to its employees in a secure manner that ensures that the login name and password are only shared with a specific and unique end user.  
  • Responsible person will advise and require all employees to safeguard their login names and passwords.
  • Responsible person will review its environment monthly and immediately contact the AHS Information Systems Department if users have a change in responsibility and no longer need access to the AHS system.

I agree to the terms of the Confidentiality Policy.

User Information (Person receiving access)



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Meditech Access

Responsible Person: By submitting this form you acknowledge that you have reviewed the company's confidentiality policy with this user and that this request is approved.

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Please submit this form by clicking the Submit button. Access will be granted after the Affinity Health System (AHS) Information Systems Department has processed this request. Call the AHS Information Systems Help Desk with questions at (920) 628-9400.