REQUEST AND CONFIDENTIALITY AGREEMENT FOR PHYSICIANS AND OTHER AUTHORIZED USERS
of the Pueblo
Radiology Web Ambassador and Universal Manager PACS w/ access to private
The patient records available through
this data source are for the use of authorized system users only who have
signed confidentiality agreements on file with this institution. A system user
is defined as any authorized individual accessing images through this data
source. This document will serve to assure that
the system user is fully aware of the implications of information system access
and the confidentiality involved. These records contain information that is
privileged, confidential, and exempt from disclosure under applicable law. The
information being accessed includes medical images and reports, patient
demographics, and/or financial related information. Browsing information
regarding patients that are not directly under your immediate care is strictly
prohibited, as is tampering or otherwise interfering with the electronic
information delivery system. Pueblo Radiology Medical Group, Inc. and Pueblo
Radiology Associates, Inc. (hereafter collectively referred to as PRMG) agree
to provide the system user with information in electronic format, which the
system user needs to perform his/her duties.
The system user agrees to preserve the privacy and confidentiality
of any and all patient information he/she receives from PRMG and to use the
information only as needed to perform legitimate duties while providing patient
care. The system user may not divulge, copy, release, sell, or loan any
confidential information except as properly authorized by PRMG. The system user
shall treat all information obtained or received from PRMG within the
requirements of the Health Information Portability and Accountability Act of
Computers used to access the patient
information shall require a secure password to log on to the computer, and such
computers shall not be available to personnel who do not require access for
clinical purposes. This computer access password should be in addition to the
system password assigned to the system user to access the confidential
information. At all times, the system user shall restrict access to the PRMG PACS
only to those persons who require access to such information for patient care.
The system user shall notify PRMG in the
event of any unauthorized access to the system or confidential information
contained thereon. Such notice will include as much information about the
breach of security and unauthorized access as possible including the name of
the person accessing the system, the names of patient’s who information was
improperly accessed, the date and time of such access, and any other pertinent
data available to the system user.
The system user agrees to accept responsibility for all activities
undertaken using his/her access code and other authorization. The system user
will also agree not to disclose his/her access code or any other authorization
that allows access into the system to any other individual or group.
The system user agrees to immediately notify the PRMG PACS
Administrator or Information Systems Department if he/she has reason to believe
that the confidentiality of his/her access code has been compromised or broken.
PRMG will reserve the right to issue a new access code.
PRMG reserves the right to revoke any
access code without reason or prior notification. Should such action take
place, the user will be notified in writing, that his/her code has been revoked
OWN ACTS: Each party will be responsible for its own acts or omissions and all
claims, expenses, liabilities, injuries, suits, and damages which may result or
arise out of any alleged malfeasance or neglect caused or alleged to have been
caused by either party, their employees or representatives, in the performance
or omission of any act or responsibility of either party under this agreement.
In the event that a claim is made against both parties, it is the intent of
both parties to cooperate in the defense of said claim and to cause their
insurers to likewise. However, both parties shall have the right to take any
and all actions they believe necessary to protect their interests.
Your user ID for the Web
Ambassador and DR Universal Manager applications is the first letter of your
first name followed by your last name. (i.e.: John Brown would be jbrown). If
the username is unavailable, we will assign a “1” between the first initial and
last name (i.e. “j1brown”). Once we have received your password request, we
will assign you a personal password and notify you of your access privileges.
Please FAX this request to: (805) 682-3321
OR scan & email to: firstname.lastname@example.org
Once you have been entered into the “Pueblo Web
Images” server, we will let you (or your administrator) know by e-mail or phone
confirmation. At that time, please follow these instructions:
• At the DR User Login window enter your assigned
user name and password.
Please note: If you have current access to another DR
PACS database such as Cottage or Sansum, feel free to use the same user
name and password for your convenience. Please complete and return this
c/o Pueblo Radiology
P.O. Box 1326
Santa Barbara, CA 93102
Tel: (805) 682-7744 x2055