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MEMORIAL HEALTH SERVICESREMOTE ACCESS PERMISSIONEMPLOYEES, WORKFORCE AND PHYSICIANS
In connection with your professional relationship (Employee, Workforce Member, or Physician) with MemorialHealth Services (“
MHS
”), MHS is granting you permission to access certain of its systems (the “
Systems
”)remotely. This permission is subject to your strict adherence to the restrictions and limitations described below.The ability to access the Systems remotely is a privilege, not a right, which may be modified or revoked by MHS atany time, without cause or notice.1.
 
Workplace Safety
. You are responsible for regularly checking your remote workspace to ensure it complies withall health and safety requirements, including appropriate workstation configuration for reduction of repetitive stressand other similar injuries. MHS does not control and has no responsibility or liability for ensuring the health andsafety of the location from which you remotely access the Systems.2.
 
Use of Remote Access Technology
. You must perform your work using only a computer provided by MHS or apersonal computer that meets the technical requirement defined in Appendix A. All remote access must be madeusing only those procedures specified by MHS and only for the purposes specifically authorized by MHS. You areresponsible for ensuring only MHS authorized personnel (e.g., no family members, office staff) will have access to(i) MHS provided computers, (ii) confidential and proprietary Information, or (iii) MHS system access procedures.
In the event you become aware of any unauthorized access to the Systems or MHS’ data or confidentialinformation, you must immediately notify the MHS Service Desk at 562-933-9450
. You may not sell orotherwise dispose of any computer, laptop, or other equipment provided by MHS. You must at all times ensure thataccess to the equipment is limited as described in this provision. In particular, you may not leave unattended acomputer remotely connected to the Systems (e.g., go to lunch with your computer logged into our systems). Youmay not copy MHS confidential or proprietary information to any form of Removable Media (defined below). Inthe event MHS confidential or proprietary information is reduced to printed form (e.g., by a printer or fax), allcopies of such printouts must be returned to MHS. Papers containing MHS confidential or proprietary informationthat are no longer needed may not be disposed of at your remote work location. All such papers must be returned toMHS for proper destruction.For purposes of this Agreement, “
Removable Media
” means portable or removable hard disks, floppy disks, USBmemory drives, zip disks, optical disks, CDs, DVDs, digital film, memory cards (e.g., Secure Digital (SD), MemorySticks (MS), CompactFlash (CF), SmartMedia (SM), MultiMediaCard (MMC), and xD-Picture Card (xD)),magnetic tape, and all other removable data storage media.3.
 
Work Site Inspections
. On reasonable notice, you agree to permit MHS to inspect the location and computersfrom which you access the Systems remotely.4.
 
Compliance with all Applicable Policies
. Although you may be authorized to work at a remote work location,you will still be obligated to comply with all applicable MHS policies and procedures, including those relating toinformation security, confidentiality, privacy, and use of information technology.5.
Supporting and Defining Policy.
At all times your actions and use of MHS computing resources must beconsistent with MHS policy, specifically, “Policy Regarding Responsible use of Technology Resources andInformation”. A copy is attached this participation agreement.
I understand that in signing this permission form I am acknowledging I have read, understand, and agree tobe bound by the restrictions and limitations described above.Applicant: Date:__________Memorial Health Services: ____________________________________________ Date: __________
LACA_-9135.1
 
APPENDIX A HARDWARE REQUIREMENTS AND ASSISTANCE
 
Minimum Requirements:
 
PC only with Windows XP SP2
 
5-10 MB of available HD space
Minimum Web Browser Requirements:
 
Internet Explorer Version 6.0 or above (Preferred and supported MHS Standard)
 
Netscape Navigator 3.01 or above (Not Supported)
 
AOL browser is not compatible with SRA
Security Requirements:
 
Current enabled Anti Virus Software
 
Password protected Access System
 
Password resume screen saver every 3 minutes
Supported Internet Service Provider (ISP)
 
For remote Workstation locations, applicant will obtain Internet access through an Internet ServiceProvider at applicant’s expense.
DSL/Cable Minimum Requirements
 
DSL/Cable minimum connection speed 128/764
Please Note: SRA Client software (Nortel) may not work on workstations with other VPN clients installed.
 
Email Support:
 
hmanager@memorialcare.org
Phone Support:
 
Phone support for Remote Access is provided through the MHS Service Desk at 562-933-9450 (24x7).
APPENDIX B
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APPLICATION FOR REMOTE ACCESSTO THE MEMORIALCARE NETWORK
Date of Request: _____________________________________________________Campus AMMC LBMMC OCMMC SMMCMHS Employee Name: ________________________________________________(First and Last Name,
please print
)Employee/Non-Employee ID: __________________________________________Dept Name/Cost Center: _______________________________________________MHS Approving Manager Name: ________________________________________MHS Manager Telephone Number: _______________________________________Justification: _________________________________________________________Home Address: _______________________________________________________Home Phone Number: _________________________________________________Office Phone Number: _________________________________________________Fax Number: _________________________________________________________Email Address: _______________________________________________________System Applications Required:___________________________________________(i.e., Epic, Cerner, Keane, 3M)E-MAIL: Outlook Web Access (Allows you to use any PC that has Internet Access to retrieve email)Outlook Client (You must have Outlook installed on the Access System)When complete fax or scan email completed pages 1 and 3 , to the appropriate Campus Security Administrator:
Anaheim Memorial Medical Center
1211 W. La Palma. Anaheim, CA. 92801Sharon Morris/Carole Alaimo 714-999-3220 faxsmorrison@memorialcare.org 
Long Beach Memorial Medical Center
2801 Atlantic Ave. Long Beach, CA. 90806MHS Service Desk 714-377-6794 faxhmanager@memorialcare.org Campus Security Administrators continued on next page.
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