Administrative User Attestation

As a Participant or Provider/Supplier in a Collaborative Health Systems, LLC (“CHS”) Value Based Healthcare Program my practice will access certain CHS information system(s) (“System”) which requires me to manage the permissions to System(s) for appropriate users and monitor these users’ access to the System(s) as an “Administrative User”. By attesting below, I attest to reading and understanding policies and procedures applicable to information security and privacy (collectively, the “Policies”) and completing any required training(s) associated with such Policies.

In exchange for receiving access to the System(s) and as part of my responsibilities as an Administrative User, I acknowledge each of the following:

• Users may be granted only the minimum necessary access to each CHS System to minimize risks to security
• All access granted to a CHS System shall be limited in duration and revoked immediately (not to exceed 24 hours) when no longer needed, such as when a user changes roles or is terminated
• I have reviewed and understand all required Policies, including but not limited to:
• minimum necessary access;
• monitoring use of accounts;
• user access grant and termination.
• I have completed all Practice or information security and privacy trainings applicable to my role at the Practice.
• I understand that it is my responsibility on behalf of my Practice to ensure that user access to CHS Systems is audited at least monthly and that users’ access is removed or adjusted in conformance with the Policies.
• I will immediately report to CHS any use or access to the CHS System(s) not in conformance with the Policies.

I understand and agree that the Practice is solely responsible for Practice users’ access to and use of the CHS System(s), however CHS may periodically monitor the System for health, quality and other lawful purposes. Practice users do not have any reasonable expectation of privacy while utilizing the CHS System(s). CHS reserves the right to cooperate lawfully with legal authorities and/or third parties in the investigation of any suspected or alleged crime or civil wrong involving any CHS System(s). In the event of a conflict between the Practice’s policies and CHS’ Value Based Healthcare Program policies, the more stringent policy shall take precedence.