Mobile Device Agreement Date Date Format: MM slash DD slash YYYY Name* First Last Device Type*iphoneandroidMobile Devices: This includes but is not limited to, laptops, smartphones, portable storage devices, flash memory devices, etc. At a minimum, all mobile storage devices shall be secured through access control techniques (username/password, PIN numbers, biometrics, etc.). All storage devices shall use encryption techniques to minimize the probability of a lost or stolen device relinquishing ePHI or other confidential information. (Device encryption is enabled by setting a username/password, PIN number, Fingerprint, Face ID or other biometric authentication) In the event of a lost/stolen mobile device, the HIPAA Security Officer will be notified, and the mobile account will be suspended. Best Practices for Securing Information: Access PHI information only in support of your job duties Comply with all CMHA HIPAA Security Policies and Procedures I Understand that the user is responsible, and will be held accountable for the security of protected health information that I access and/or maintain. Signature* I certify that I am an employee or contractor working for or on behalf of CMHA, and that I have read and understand CMHA’s policies and procedures regarding mobile device use. I understand that failure to observe and abide by these obligations may result in disciplinary action, which may include dismissal and/or contract termination. I also understand that in some cases, failure to observe and abide by these obligations may result in criminal or other legal actions.I understand that checking this box constitutes a legal signature confirming all information provided on this application is true and accurate
