• Network and or Cerner Sign-On Request Form

  • The Niagara Falls Memorial Medical Center (NFMMC) Network and/or Cerner Sign-On Request Form (IS Form) is used to validate information about a user.  When the IS Form is received, it will be reviewed by the Information System Department and validated with Human Resources.

    Network and/or Cerner Sign-On requests have to go through the following steps:

     

    Step 1: NFMMC Manager Approval – by submitting this form through the NFMMC Intranet, the manager or supervisor is approving the individual for access to the NFMMC network and the systems listed on this form.

    Step 2: This request will be validated by the Information Systems Department with the Human Resources Department to ensure the individual has attested to receiving NFMMC Policy A-50 Department of Information Systems E-Mail and/or Internet Usage Policy.

    Step 3: This request will be processed by the Information Systems Department for network, e-mail and Cerner account creation.  Those credentials will be sent to the manager or supervisor who completed this form and this form will then be forwarded to the appropriate departments for additional departmental system account creation (Pyxis, Sage AccPac, ADP, etcetera).

     

    Estimated Timeframe 1 - 10 days depending on the volume of requests in the queue when received.

    If you need assistance or have any questions or concerns, please contact the Information Systems Help Desk at (716) 278-4371.

  • ACTION:*
  • REASON:*

  • YOU MAY CHOOSE YOUR OWN NETWORK PASSWORD.

    Passwords must mixed-case alpha numeric, and be a minimum of 8 characters long. If you do not enter a password below, one will be assigned to you.
  • Need Cerner*
  • Departments/Systems – Check all that apply:

  • Confidentiality Notification and Acknowledgement

    • I have been issued an access code to the computer system, which will be necessary for me to perform my duties. I will use only my code and no other employee’s code nor will I allow any other employee to use my code. I will sign-off from the system upon completion of my activity.
    • This access code is to be kept confidential and is the legal equivalent of my signature and any on-line use represents my signed authorization.
    • I understand that certain information in the system is specifically excluded from my access code and no attempts will be made to access that information.
    • I further understand that although my access code may provide unrestricted access to certain functions, these functions are only to be used when there is clear clinical or business reason to access that information.
    • If it is my belief that anyone may have discovered my access code, it is my responsibility to immediately advise my supervisor or manager and a new code will be issued.
    • I recognize that I may be subject to disciplinary action up to and including dismissal for the improper use of this access code.
    • I understand that Protected Health Information (PHI) to which I have access is confidential.
    • I understand that unauthorized use or disclosure of PHI is grounds for disciplinary action up to and including dismissal.
    • I am aware that I may be subject to criminal penalties, in addition to disciplinary actions if I improperly disclose or allow the disclosure of PHI.

  • I hereby acknowledge that I have received and have read the confidentiality notification and acknowledgment statement.

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  • Training Date:
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  • Call the Help Desk (4371) with any questions or concerns.

  • Internet and or E-Mail Access Request and Agreement

  • Please specify any e-mail groups to be included in:

    Example: Department Managers, HIPAA Team, Nursing Clinical Coordinators

  • Specific activities that are strictly prohibited:

    • Any disclosure of NFMMC’s confidential or proprietary information to unauthorized individuals.
    • Sending protected health information over the internet unless it is encrypted before sending.
    • Sharing of user IDs (logon Ids) and/or passwords with any other person.
    • The use of pseudonyms or other “Ids” specifically designed to hide or mask the true identity of the employee. 
    • Impersonation of another individual or organization.
    • Any unauthorized or deliberate action which damages or disrupts a computing system or network, alters their normal performance, or causes them to malfunction regardless of location or duration.
    • The willful or negligent introduction of computer viruses or other destructive programs into NFMMC system or networks or into external systems and networks.
    • Decryption or attempt to decrypt user passwords or any encrypted file.
    • Packet sniffing, packet spoofing or use of any other means to gain unauthorized access to a computing system or network.
    • The use, transmission, duplications or voluntary receipt of material that infringes on the copyrights, trademarks, trade secrets or patent rights of any person or organization.
    • Downloading of any “shareware” programs or files.
    • Any conduct that would constitute or encourage a criminal offense of give rise to civil liability, or otherwise violate any local, state, national or international law, including without limitation US export control laws and regulations.
    • The transmission of private, commercial, advertising, political material, or solicitations for outside business ventures, organizational campaigns, or political or religious causes.
    • The creation, posting, transmission or voluntary receipt of any unlawful, offensive, libelous, threatening, abusive, profane, or harassing material, including but not limited to comments based on race, national origin, sex, sexual preference, age, disability, religion, physical attributes, health condition or political beliefs.
    • The creation, posting, transmission or voluntary receipt of defamatory material.
    • The creation, posting, transmission or voluntary receipt of obscene, pornographic or indecent images, data or other material, or any data capable of being resolved into obscene, pornographic or indecent images or materials.
    • Any ordering (shopping) of personal items or services on the Internet.
    • The playing of games.
    • Any form of gambling.
    • Participation in any on-line contest or promotion or acceptance of promotional gifts.
    • All existing NFMMC sexual harassment policies apply to E-Mail transmissions.
    • Use of hyperlinks, chat rooms, or bulletin boards for political statements.
    • Listening to streaming audio or watching streaming video for personal reasons.
    • The transmission of information related to a lawsuit or investigation and may not criticize, involve or disclose any activity that could adversely affect the institution, its officers and employees, or others.

  • Ownership and User Privacy of E-Mail and the Internet


    Use of electronic mail and the Internet is a part of Niagara Falls Memorial Medical Center’s business processes.  All messages originated or transported within or received into Niagara Falls Memorial Medical Center’s electronic mail system are considered to be the property of Niagara Falls Memorial Medical Center.  All users of Niagara Falls Memorial Medical Center’s e-mail and internet systems do so with the understanding that they have NO EXPECTATION OF PRIVACY relating to that use.  Niagara Falls Memorial Medical Center reserves the right to access the electronic mail system for the purpose of ensuring the protection of legitimate business interests and proper utilization of its property.  Such purposes may include but are not limited to:

    1. Locating and retrieving lost messages;
    2. Performing duties when an employee is out of the office or otherwise unavailable;
    3. Maintaining control of the system by analyzing message patterns and implementing revisions as needed;
    4. Collecting or monitoring electronic communications in order to ensure the ongoing availability and reliability of the system;
    5. Recovering from systems failures and other unexpected emergencies;
    6. Investigating suspected breaches of security or violations of policy with probable cause;
    7. Logging and monitoring of activity.

  • Security Information

    The signatures below indicate that you and your Supervisor have read and understand the E-Mail and/or Internet Policy and agree to adhere to it. If you have not read this policy, a copy may be obtained from your Supervisor or the Chief Information Officer. Any violations of this policy may result in disciplinary action up to and including termination of employment.
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  • Date*
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  • Should be Empty: