EHR ACCESS AGREEMENT FOR MHES 8-20-2018 (FINAL).PDF

MARICOPA COUNTY
CORRECTIONAL HEALTH SERVICES – FORENSIC SERVICES
Electronic Health Record and Criminal Justice Record
Access Agreement for Mental Health Expert
I, ____________________________________, acknowledge that as a Mental Health Expert
appointed by the Superior Court of Arizona in Maricopa County, I may be authorized to access and
review Maricopa County Correctional Health Services ("CHS") information concerning defendants. I
understand that in the course of my work and experience I may have access to and learn privileged
and confidential health information about defendants obtained or maintained by CHS in oral,
electronic and /or paper form. I may also have access to and learn confidential criminal justice
information about defendants, which is information collected by criminal justice agencies on
individuals consisting of identifiable descriptions and notations of arrests, detentions, indictments,
information, or other formal criminal charges, and any disposition arising therefrom. I understand
that pursuant to CHS policies and federal and state laws, the foregoing “Confidential Information” is
protected in every form, such as written records and correspondence, oral communications,
electronic communications, computer programs and electronic applications.
I understand and agree that Confidential Information accessed and/or retrieved from CHS
Information Systems by me as an authorized user shall be limited to the purpose of a court-ordered
business need, including, but not limited to, a court-ordered evaluation conducted pursuant to either
Arizona Revised Statutes §§ 8-291 et seq., 13-502, 13-753, 13-754, 13-4022, or 13-4501 et seq.,
and/or Rule 11 or Rule 26.5 of the Arizona Rules of Criminal Procedure (“Authorized Use”). I
understand and agree that access and/or retrieval of Confidential Information for any other purpose
is expressly prohibited and may be a violation of federal and/or state law.
I understand that access to the CHS Information Systems will be recorded electronically and
access and use may be audited by CHS at any time on a random basis or for cause. As a user, I
consent to having all or any part of my use of and access to the CHS Information Systems
recorded, audited or reviewed at any time.
I agree not to share or release any authentication credentials (USERID or passwords) to any other
person, or to fail to take appropriate measures to safeguard my authentication credentials. I also
agree not to use anyone else's authentication credentials. I agree not to allow any other person to
have access to CHS Information Systems under my authentication credentials. I agree to notify the
CHS Contract Administrator at (602) 376-3080 immediately if I become aware that another person
has access to my authentication credentials, or otherwise has exercised unauthorized access to
CHS Information Systems. I agree to notify the CHS Contract Administrator immediately if I have
inadvertently accessed an incorrect electronic health record or otherwise accessed Confidential
Information outside the scope of my Authorized Use.
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I agree not to use or disclose Confidential Information other than as permitted or as required by law.
I further agree to use appropriate safeguards and practices to prevent access, use and/or
disclosure of the Confidential Information other than as provided for in this Agreement, including but
not limited to the following:
• I will not download electronic health record documents to a computer or external
device.
• If documents are printed for Authorized Use, they should be kept secure while in
use and shredded when no longer needed.
• Defendant information may not be left displayed on a computer screen
unattended. I will log out of the application before stepping away from the
computer.
I agree to comply with all applicable federal and state laws and regulations which protect the
Confidential Information. I further agree not to act or fail to act in a way that would cause CHS to be
noncompliant with applicable federal or state laws or regulations which protect the Confidential
Information. I will cooperate to mitigate, to the extent practicable, any harmful effect that is known to
me of a use or disclosure of Confidential Information in violation of the requirements of this
Agreement.
I have read and understand this Agreement and agree to be bound by its terms and conditions and
protect the Confidential Information to which I may be granted access. Additionally, I understand
that if I reveal Confidential Information without proper authorization, I may be subject to criminal and
civil penalties or liabilities under state and federal laws.
Signature
Printed Name
Date
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