Get External Access Confidentiality Statement - Nebraska Health And ... - Dhhs Ne

Filling out the External Access Confidentiality Statement is an important step for individuals seeking access to Nebraska Health and Human Services information systems. This guide provides clear and supportive instructions to ensure users can complete the form accurately and efficiently online.

Follow the steps to successfully complete the External Access Confidentiality Statement online.

1. To obtain the External Access Confidentiality Statement form, click the ‘Get Form’ button to access the document and open it for editing.
2. Begin by clearly printing your name in the 'Employee Name' field. Ensure that your name is legible and correctly spelled.
3. In the 'Employee Title/Position' section, provide your current job title or position within the organization.
4. Sign the document in the designated 'Employee Signature' area to confirm your agreement with the confidentiality requirements.
5. Fill out your work phone number in the corresponding field, ensuring that it can be easily reached during business hours.
6. Enter the date of your signature in the 'Date' field to indicate when you completed the form.
7. Input your work email address in the specified field to provide a means of electronic communication.
8. Complete the 'Employer/Agency Name' section with the full name of your organization.
9. Provide the address of your employer or agency, filling in the address, city, and zip code accurately.
10. If your work site differs from the above address, provide the relevant information in the space provided.
11. Next, fill in the immediate supervisor's printed name and position title.
12. Complete the supervisor's work phone and email fields to ensure they can be contacted for any follow-up.
13. Have your immediate supervisor sign the document as required.
14. Indicate whether your supervisor has access to a DHHS application and provide necessary details about the supervisor if they do not.
15. Answer the questions regarding previous access to DHHS applications, noting any relevant details as necessary.
16. If applicable, state whether you are replacing existing staff or if you need to retain access despite a new position within the same organization.
17. Once all sections of the form are completed, save your changes and consider downloading or printing a copy for your records.

Complete your External Access Confidentiality Statement online to ensure secure access to DHHS information.