MEMORIAL HEALTH SERVICES

REMOTE ACCESS PERMISSION

EMPLOYEES, WORKFORCE AND PHYSICIANS

In connection with your professional relationship (Employee, Workforce Member, or Physician) with Memorial
Health Services (“MHS”), MHS is granting you permission to access certain of its systems (the “Systems”)
remotely. This permission is subject to your strict adherence to the restrictions and limitations described below.
The ability to access the Systems remotely is a privilege, not a right, which may be modified or revoked by MHS at
any time, without cause or notice.
1. Workplace Safety. You are responsible for regularly checking your remote workspace to ensure it complies with
all health and safety requirements, including appropriate workstation configuration for reduction of repetitive stress
and other similar injuries. MHS does not control and has no responsibility or liability for ensuring the health and
safety of the location from which you remotely access the Systems.
2. Use of Remote Access Technology. You must perform your work using only a computer provided by MHS or a
personal computer that meets the technical requirement defined in Appendix A. All remote access must be made
using only those procedures specified by MHS and only for the purposes specifically authorized by MHS. You are
responsible for ensuring only MHS authorized personnel (e.g., no family members, office staff) will have access to
(i) MHS provided computers, (ii) confidential and proprietary Information, or (iii) MHS system access procedures.
In the event you become aware of any unauthorized access to the Systems or MHS’ data or confidential
information, you must immediately notify the MHS Service Desk at 562-933-9450. You may not sell or
otherwise dispose of any computer, laptop, or other equipment provided by MHS. You must at all times ensure that
access to the equipment is limited as described in this provision. In particular, you may not leave unattended a
computer remotely connected to the Systems (e.g., go to lunch with your computer logged into our systems). You
may not copy MHS confidential or proprietary information to any form of Removable Media (defined below). In
the event MHS confidential or proprietary information is reduced to printed form (e.g., by a printer or fax), all
copies of such printouts must be returned to MHS. Papers containing MHS confidential or proprietary information
that are no longer needed may not be disposed of at your remote work location. All such papers must be returned to
MHS for proper destruction.
For purposes of this Agreement, “Removable Media” means portable or removable hard disks, floppy disks, USB
memory drives, zip disks, optical disks, CDs, DVDs, digital film, memory cards (e.g., Secure Digital (SD), Memory
Sticks (MS), CompactFlash (CF), SmartMedia (SM), MultiMediaCard (MMC), and xD-Picture Card (xD)),
magnetic tape, and all other removable data storage media.
3. Work Site Inspections. On reasonable notice, you agree to permit MHS to inspect the location and computers
from which you access the Systems remotely.
4. Compliance with all Applicable Policies. Although you may be authorized to work at a remote work location,
you will still be obligated to comply with all applicable MHS policies and procedures, including those relating to
information security, confidentiality, privacy, and use of information technology.
5. Supporting and Defining Policy. At all times your actions and use of MHS computing resources must be
consistent with MHS policy, specifically, “Policy Regarding Responsible use of Technology Resources and
Information”. A copy is attached this participation agreement.

I understand that in signing this permission form I am acknowledging I have read, understand, and agree to
be bound by the restrictions and limitations described above.

Applicant: Date:__________

Memorial Health Services: ____________________________________________ Date: __________

LACA_-9135.1
 APPENDIX A HARDWARE REQUIREMENTS AND ASSISTANCE

Minimum Requirements:
• PC only with Windows XP SP2
• 5-10 MB of available HD space

Minimum Web Browser Requirements:

• Internet Explorer Version 6.0 or above (Preferred and supported MHS Standard)
• Netscape Navigator 3.01 or above (Not Supported)
• AOL browser is not compatible with SRA

Security Requirements:
• Current enabled Anti Virus Software
• Password protected Access System
• Password resume screen saver every 3 minutes

Supported Internet Service Provider (ISP)

• For remote Workstation locations, applicant will obtain Internet access through an Internet Service
Provider at applicant’s expense.

DSL/Cable Minimum Requirements

• DSL/Cable minimum connection speed 128/764

Please Note: SRA Client software (Nortel) may not work on workstations with other VPN clients installed.

Email Support:
• hmanager@memorialcare.org

Phone Support:
• Phone support for Remote Access is provided through the MHS Service Desk at 562-933-9450 (24x7).

APPENDIX B

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 APPLICATION FOR REMOTE ACCESS
TO THE MEMORIALCARE NETWORK

Date of Request: _____________________________________________________

Campus AMMC LBMMC OCMMC SMMC

MHS Employee Name: ________________________________________________

(First and Last Name, please print)

Employee/Non-Employee ID: __________________________________________

Dept Name/Cost Center: _______________________________________________

MHS Approving Manager Name: ________________________________________

MHS Manager Telephone Number: _______________________________________

Justification: _________________________________________________________

Home Address: _______________________________________________________

Home Phone Number: _________________________________________________

Office Phone Number: _________________________________________________

Fax Number: _________________________________________________________

Email Address: _______________________________________________________

System Applications Required:___________________________________________

(i.e., Epic, Cerner, Keane, 3M)

E-MAIL: Outlook Web Access (Allows you to use any PC that has Internet Access to retrieve email)

Outlook Client (You must have Outlook installed on the Access System)

When complete fax or scan email completed pages 1 and 3 , to the appropriate Campus Security Administrator:

Anaheim Memorial Medical Center

1211 W. La Palma. Anaheim, CA. 92801

Sharon Morris/Carole Alaimo 714-999-3220 fax smorrison@memorialcare.org

Long Beach Memorial Medical Center

2801 Atlantic Ave. Long Beach, CA. 90806

MHS Service Desk 714-377-6794 fax hmanager@memorialcare.org

Campus Security Administrators continued on next page.

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 Orange Coast Memorial Medical Center

18109 Brookhurst St. Fountain Valley, CA. 92708

Leigh Ann Lambert 714-378-7985 fax llambert@memorialcare.org

Saddleback Memorial Medical Center

24451 Health Center Drive. Laguna Hills, CA. 92563

Michelle Kirkpatrick 949-452-3440 fax mmkirkpatrick@memorialcare.org

Please direct any questions to the MHS Service Desk at (562) 933-9450. Thank you!

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