ONLINE ACCESS AGREEMENT

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To assist in the prompt evaluation, diagnosis and treatment of their patients’ medical conditions, Imaging Associates (IA) offers those medical providers and staff that refer patients (each a “Referring Provider”), the option of obtaining online reports and images via the IA Online System (the “IA System”). To obtain access to the IA System, please provide the following information to each Referring Provider and staff and return with proof that such medical provider(s) is/are a duly licensed professional in the State of Alaska. Call Kayla at (907) 306-7755 or Jacob at (907) 290-4844 to obtain the code needed to complete the sign-up process.
  • Please read and agree to the conditions
  • Upon receipt of this completed form, and verification that the appropriate licensure affixed hereto is in good standing, the Referring Provider identified will be provided with a username and a confidential password to access the IA System. Each Referring Provider is responsible for protecting the confidential password(s) issued and limiting access to the IA System to those of its Assistants whom the Referring Provider may designate to access such information on the Referring Provider’s behalf. Referring Provider agrees to apprise each designee that receives a password of the terms of this Agreement, and shall be responsible for assuring compliance with such terms at all times. By signing this Agreement, Referring Provider acknowledges that patients have an expectation of privacy in their medical records and personal identifying information, and agrees to remain responsible for complying with the requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and the regulations promulgated thereunder, to protect the confidentiality of the information that may be accessed on the PENRAD System. You further agree (1) to use protected health information (“PHI”) for the purpose of diagnosis and/or treatment of your patient(s), and for no other purpose except those permitted or required by applicable federal and state law; (2) to use appropriate safeguards to prevent the use or disclosure of patient information other than as permitted pursuant to this agreement or applicable federal and state law; (3) to make certain that your employees or other agents who you authorize to access this web portal comply with the provisions of this agreement and applicable federal and state law; and (4) to allow access to the web portal only to those personnel with an essential need for access and who request access user names and user identifications unique to each individual. In the event that an employee, officer, contractor or agent of your practice has reason to believe that PHI stored or transmitted from our radiology information system (RIS) and/or picture archiving communication system (PACS) has been acquired, accessed, used, or disclosed in a manner not permitted by HIPAA, your practice must immediately report the suspected or actual breach to the IA Privacy Officer at (907) 222-4624. The report must be made within 24 hours of becoming aware of a suspected or actual breach The Privacy Officer will coordinate with appropriate management personnel and legal counsel to determine if a Breach of PHI occurred and whether the Breach gives rise to any reporting obligations under federal or state law. To further protect the security of the IA System, Referring Provider shall promptly notify IA of any changes in the employment status of any Assistant that is given access to the IA System. Referring Provider represents and warrants that he/she is appropriately licensed to render medical services and refer patients for radiology services in the State of Alaska and will maintain such professional licensure in good standing, at all times hereunder. Notwithstanding, IA retains the right to revoke the Referring Provider’s access to the IA System in its sole discretion. For HIPAA and security reasons, all passwords will expire every 180 days. Please agree to the above terms and conditions by checking yes when you fill out the on-line account request *
  • Please fill out this form and agree to the terms and conditions*