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Please make note of the e-mail address and password used, as you will need it for future system use.
New User Details
JOB SHADOW APPLICATION
*Note: Virginia Mason Memorial's (VMM) job shadow program is open to anyone age 18 or over who is considering healthcare as an occupation. This program allows up to 20 hours shadow time within one year.
Please review the required items on the application prior to completing the form. The application does not offer the capability of saving and logging back into it.

There is a document link at the bottom of the application. Please ensure that you either have the ability to download the file to your computer or onto a jump drive, so you are able to review the document while you take our online quiz. Once your application has been submitted, you will be automatically redirected to our Orientation Quiz.
CRIMINAL HISTORY (RCW 10.97)
All information is required and failure to complete may affect results of inquiry and placement.
REQUIRED IMMUNIZATIONS

Health Requirements: Non-Employees (regardless of direct patient care) are required to meet the same health requirements as employees of VMM and its Affiliates. Health requirements are established in response to current Communicable Disease Center (CDC) for Healthcare Providers.
* One-Step Tuberculosis Skin Test (TST)
* Influenza vaccine- Vaccine will be required annually between November 1- May1.
***VMM reserves the right to require other potential vaccinations as guided per recommendations of the CDC and adopted by the Infection Control Department.***

ACCEPTABLE USE POLICY
Purpose
Virginia Mason Memorial Hospital (VMM) is responsible for securing its computer systems, associated data, and communications network. In addition, VMM and affiliated agency employees are responsible for preventing the occurrence of inappropriate, unethical, or unlawful use of such systems and data.
General Principles
Access to computer systems and networks owned or operated by VMM imposes certain responsibilities and obligations, and is granted subject to Hospital policies, and local, state, and federal laws*. Acceptable use is always ethical, legal, and maintains patient confidentiality, protects the Hospital's interests, and shows restraint in the consumption of shared system resources.
Guidelines
ACCEPTABLE USE
Acceptable use of information systems includes, but is not limited to:

*Using computing resources only for authorized purposes
*Protecting your computer equipment, user-ID, and password from unauthorized use. You are responsible for all activities associated with your user-ID, or that originate from your equipment.
*Accessing only files and data that are your own, which are publicly available, or to which you have been given authorized access
*Using only legal versions of copyrighted software in compliance with vendor license requirements and as approved by the VMM Information Systems Department.
UNACCEPTABLE USE
Unacceptable use of information systems includes, but is not limited to:

*Using another person's user-ID or password
*Using another person's system, files, or data without permission
*Attempting to circumvent or subvert system or network security measures
*Engaging in any activity that might be harmful to systems, or to any information stored thereon, such as the creation or propagation of viruses, disruption of services, or damage to files
*Using Hospital systems for commercial, political, or extensive personal use
*Installing or using illegal copies of copyrighted software, or any other software without prior approval from the VMM Information Systems department
*Using mail or messaging services to harass, intimidate, or otherwise annoy another person
*Engaging in any other activity that does not comply with the general principles presented above
Enforcement
The Hospital considers any violation of acceptable use principles and guidelines to be a serious offense and reserves the right to copy and examine any files or information resident on the Hospital systems. Violators will be subject to appropriate disciplinary action as prescribed in other Hospital policies.

ID Badge MUST be returned to Education Coordinator upon completion of internship.


CONFIDENTIALITY AGREEMENT
I understand that I may have access to protected health information (PHI) and confidential information about the business and financial interests (referred to as "Confidential Information" in this Agreement) of Virginia Mason Memorial (VMM). I understand that Confidential Information is protected in every form, such as written records and correspondence, oral communications, and computer programs and applications.

I agree to comply with all VMM policies and procedures to protect the confidentiality of Confidential Information. I agree not to use, copy, make notes regarding, remove, release, or disclose Confidential Information, unless it is permitted by VMM policy.

I agree not to share or release any authentication code or device, password, key card, or identification badge to any other person, and I agree not to use or release anyone else's authentication code or device, password, key card, or identification badge.

I agree to notify the appropriate manager immediately if I become aware that another person has access to my authentication code or device, password, key card, or identification badge, or otherwise has unauthorized access to the hospital's information system or records.

I agree that my obligations under this Agreement continue after my employment or my time as a student or volunteer ends.

I understand that breach of patient confidentiality may result in civil or criminal penalties under state or federal law.

HIPAA EDUCATION
HEALTH INFORMATION COVERED:
Any information, whether spoken, electronic or written that relates to the health of the individual, the health care provided to that individual or payment for health care provided is considered protected.
PATIENT RIGHTS INCLUDE:
*Knowledge of who has access to their health information
*Ability to access their medical record &/or amend incomplete or incorrect information
*Requirement of authorization before information is given, except as allowed by HIPAA
*May request an accounting of all disclosures in a six year period
*Recourse if their Rights are violated
DISCLOSURE
Any information that relates to the patient's health cannot be disclosed unless authorized by the patient or someone acting on the patient's behalf or unless permitted by HIPAA regulation. The facility must limit access to only those individuals who need the information for a legitimate purpose. Any information that is shared should be limited to the minimum necessary, the least amount of information to accomplish the purpose of the request. However, this does not apply to the sharing of the medical record for treatment purposes.
YOUR ROLE IN PROTECTING PATIENT RIGHTS
*Protect all forms of Protected Health Information (PHI)
*Only access patient PHI for which you are authorized to perform your job duties. Do not access PHI of family members, friends or anyone else for whom you don't have a direct job related purpose
*Report any observed or suspected HIPAA breaches immediately to the Privacy Line (249-8676) or your facility's Privacy Officer.
Examples of potential breaches
*Workforce members accessing electronic health records for information on friends, neighbors or family members out of curiosity/without a business-related purpose.
*Medical record documents left in public access cafeteria
*Provider accessing the health record of divorced spouse for information to be used in a custody hearing
*Misdirected fax of patient records to a local grocery store instead of the requesting provider's fax.
*Workforce members access the electronic health records of a celebrity who is treated within the facility
*Stolen or lost laptop containing unsecured, protected health information
*Papers containing protected health information found scattered along roadside after improper storage in truck by business associate responsible for disposal (shredding)
*Posting of patient's HIV+ health status on Facebook by a laboratory tech that carried out the diagnostic study
*Misdirected e-mail of listing of drug seeking patients to an external group list
*Lost flash drive containing database of patients participating in a clinical study
*EOB (Explanation of Benefits) sent to wrong guarantor
*EMT takes a cell phone picture of patient following a MVA and transmits photo to friends
*Misfiled patient information in another patient's medical records which is brought to the organization's attention by the patient
*Medical record copies in response to the payers request lost in mailing process and never received
*Briefcase containing patient medical record documents stolen from car
*PDA with patient-identifying wound photos lost
When in doubt, report it immediately!

Please select the link below and download for reference regarding VMM, policies, safety, etc. The Student Orientation link will open the orientation training that will be used to complete your orientation quiz.
CLICK HERE to download our Job Shadow Orientation ***IMPORTANT--- This file will be used to complete your orientation quiz***

I grant permission to Virginia Mason Memorial and its affiliates to verify and obtain information on my employment, school records and license/certification. I hereby release my employers, schools, references, and any agencies contacted from any and all liability of damages for providing the information requested. Further, I certify that the above information is true and correct to the best of my knowledge. I also certify that I am in compliance with the required immunizations. I understand that misrepresentation or omission of facts is cause for rejection or termination of placement. Placement is contingent upon a satisfactory Criminal History Report. I understand that this application does not create a contract of employment or promise of future employment. I understand that my request for internship is voluntary, unpaid, and can be terminated at any time at the option of either the agency or myself.
My typed name below verifies that I have read and agree to comply with the above Confidentiality, HIPAA, Patient Rights, and Acceptable Use Policy. I understand my responsibility in protecting these rights. My typed name below shall have the same force and effect as my written signature.
If you have any problems with the application process, please contact:
Paige Atterberry
Student Experience Specialist
paigeatterberry@yvmh.org
When you submit your application, please wait to be directed to complete the orientation quiz!