Assistant Center

TELECOMMUNICATIONS SECURITY AGREEMENT

Name: Kavita Patel Cost Center # 1029699

This agreement was developed to protect you and your informational needs. Please read it carefully so that you understand the responsibilities that comes with the right of access to the Adventist HealthCare long distance dialing privileges.

Please check each box after reading the sentence. I, the undersigned, acknowledge the establishment of my long distance authorization code and understand that:

My authorization code is for my exclusive use and is the equivalent of my signature; I will not disclose this authorization code information to anyone.

I will not attempt to learn another use’s password or try to use anyone else’s code.

I will not attempt to access nor input any information via the phone system other than what pertains directly to my position and / or job description, or what has been assigned to me by my superiors.

If I have reason to believe that the confidentiality of my authorization code has been broken, I will notify my supervisor of such a breech and contact I.S. Telecommunications A.S.A.P. to reestablish a new authorization code.

I will protect the confidentiality of all information in the Adventist HealthCare Information Services Network.

I understand that if I violate any of the above statements, I will be subject to disciplinary actions as stated in the institutions Personnel Policy Manual which could include immediate termination.

I further understand that my authorization code will be deleted from the Information Services Network at the time that I terminate my employment from any facility associated with the Adventist HealthCare. Should I be re-employed or transferred to any of the other department or facilities, I will be required to establish an authorization code.

Signature Date of Issue

Name: Kavita Patel

Cost Center # & Department Name: 1029699 PHYSICIANS ASSISTANT

Long Distance Authorization Code : 13943

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