Common Contracts
1 similar System User Agreement contracts
SYSTEM USER AGREEMENTSystem User Agreement • October 16th, 2011
* LAST NAME * LEGAL FIRST NAME MI *PHONE # (Required) PAGER * E-MAIL ADDRESS *BUSINESS NAME (Required) JOB TITLE/DESCRIPTION UAMC POINT OF CONTACT / PHONE NO.: FUNCTION: MEDICAL / CLINICAL STAFF NEW HIRE TEMP CONCURRENT/UTILIZATION REVIEW ✔ CONSULTANT / CONTRACTOR / VENDOR OTHER: PURPOSE: PATIENT TREATMENT/CARE BILLING/PAYMENT MAINTENANCE/SUPPORT RESEARCH - RESEARCH IRB/VOTF Number/Sponsor Required : ✔ APPLICATIONS: ALLSCRIPTS-EHR SUNRISE ENTERPRISE GATEWAY CHARTMAXX CRITICAL CARE MANAGERSYNAPSE (PACS) IDX-SCHED AMTELCO WEB ✔ OTHER (Identify Application): EPIC-HIM Release Inspector (Non UAHN) ✔ CITRIX (REMOTE ACCESS) E-MAIL VPN OTHER (Please Describe): UAHN CONFIDENTIALITY / NON-DISCLOSURE AGREEMENTThe confidentiality and integrity of organization information are to be preserved at all times. Organizational information that includes, but is not limited to, patient identifiable, employee identifiable, financial, intellectual property, financially non-public, contractual, of
