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Qld. gov.au Fax 07 3000 9330 Phone 07 3000 9333 Address Technology Office Park Building No. 4 107 Miles Platting Road Eight Miles Plains QLD 4113 Page 1 of 1 Document Number 28386V3 Valid From 15/01/2015 Approver/s Morgan PASCOE Need more information CISSU home page on QHEPS http //qheps. AUSLAB/AUSCARE clinical and scientific information system Pathology WIL Student access request AUSLAB and AUSCARE are registered trademarks of PJA Solutions Pty Ltd Privacy disclaimer Personal information collected by the Department of Health or a Hospital and Health Service a health agency is handled in accordance with the Information Privacy Act 2009. In particular I will keep confidential all personal patient and client information acquired in the course of using AUSLAB/AUSCARE. I understand that AUSLAB/AUSCARE contains confidential patient information and access is restricted to enquiries made in the direct course of Queensland Health s mission. Unauthorised access and or use of AUSLAB/AUSCARE will result in loss of access privileges and other remedies available to Queensland Health at law. I will regard logins and passwords as confidential and will not share or reveal my login details to another person. Date Applicant s signature Executive Director of Medical Services Pathology Queensland approval Access will NOT be provided without Name Phone number I declare that the applicant although not an employee of Queensland Health is engaged in WIL in Pathology Queensland laboratories and requires access to AUSLAB/AUSCARE. I recommend that the applicant be given user L1 access to the AUSLAB clinical and scientific information system. Authorisation Date Return completed form to Clinical Information System Support Unit via email or fax Email liss health. I hereby request access to AUSLAB and AUSCARE and declare that I will abide by the principles of the Code of Conduct for the Queensland Public Service the Queensland Health Information Security Policy and the Information Privacy Act 2009. In particular I will keep confidential all personal patient and client information acquired in the course of using AUSLAB/AUSCARE. I understand that AUSLAB/AUSCARE contains confidential patient information and access is restricted to enquiries made in the direct course of Queensland Health s mission. Unauthorised access and or use of AUSLAB/AUSCARE will result in loss of access privileges and other remedies available to Queensland Health at law. Applicant details Complete ALL details. Incomplete details will delay processing of your request Surname Given name Middle initial Course University Current Year Student number Expected graduation date Work phone number Work Fax Number Laboratory location University e-mail address Security policy Access will NOT be provided if this section is not signed and dated I have been provided with a copy of and understand the requirements of the Code of Conduct for the Queensland Public Service the Queensland Health Information Security Policy and the Information Privacy Act 2009. I hereby request access to AUSLAB and AUSCARE and declare that I will abide by the principles of the Code of Conduct for the Queensland Public Service the Queensland Health Information Security Policy and the Information Privacy Act 2009. Personal information recorded on this form will not be disclosed to other parties without your consent unless required by law. Applicant details Complete ALL details. Incomplete details will delay processing of your request Surname Given name Middle initial Course University Current Year Student number Expected graduation date Work phone number Work Fax Number Laboratory location University e-mail address Security policy Access will NOT be provided if this section is not signed and dated I have been provided with a copy of and understand the requirements of the Code of Conduct for the Queensland Public Service the Queensland Health Information Security Policy and the Information Privacy Act 2009..

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