June 12, 2008
Dear Case Manager
Thank you so much for the business you have sent us through the years. We appreciate you and the patients that you bring
to us and want to continue the good relationships that we have with all of you. Your participation in the care of our
patients is important to their outcomes and we value your collaboration.
We are sending you this letter in an effort to make certain we communicate recent policy changes to you. We have been
asked by Medical Center Administration to make certain that all case managers who come to patient appointments or visit
an inpatient in our hospital be easily identifiable and have photo identification visible on them at all times. At the same
time, we were notified that our Utilizaton Review office will be moving. These two situations provide us the opportunity
to revise our check-in process for the institution to one that we feel is more streamlined and secure.
In order to accomplish this we are partnering with the Vendor Liaison Program to provide you with the required facility
name badge. Upon receipt of this email, we are requesting that you complete the attached registration and confidentiality
forms and contact Lacy Hunter at 615-343-5453 or lacy.l.hunter@vanderbilt.edu to schedule a convenient time to
have your photo identification badge made. Corporate Health Services will be absorbing the cost of the name
badges. Your photo ID badge will have your name, your company name, and your photo on it. Lacy will also give you a
tutorial on how to log into the Vendor Liaison website. This entire process should take no longer than 10-15 minutes of
your time. Lacy will be scheduling appointments immediately. Please fax your completed registration form and
confidentiality agreement to our office at (615) 936-6077 as soon as possible after receiving this notification. Your name
badges will need to be renewed annually and a new registration form/confidentiality agreement will need to be completed
each year.
We are also partnering with Lacy's department to ease the check in process for inpatient visitation and outpatient visits.
Prior to coming to the hospital or any outpatient clinics to obtain information or visit your injured worker, log into the
Vendor Laison website, complete the required fields, and print your site visit form. This log should be completed on the
same day that you plan to visit. You will no longer have to check in at the Utilization Review office for inpatient
visits. For any visit (inpatient or outpatient) you will simply take your site visit form to the appropriate inpatient unit or to
the front desk in the outpatient clinic area where your claimant is receiving care and present the paper to the front desk
staff member.
You will be required to wear your photo identification and bring your site visit form any time you are on the Vanderbilt
campus OR in any of the onsite or offsite Vanderbilt Clinics. Failure to do this may result in your inability to access the
information you need on your patient.
The Vendor Liaison website is: www.vanderbilt.edu/procurement/procurement/liaison.shtml.
Please bookmark this site on your computer for future use. We realize that this is a big change and appreciate your
patience and cooperation as we move to a more streamlined, secure process for onsite visits.
Please contact us if you have questions and thank you again for the business that you send to us!
Terry Parker, RN, CRRN, CCM
Assistant Director
Vanderbilt Corporate Health Services
Vendor Registration Form
Vendor Representative Home Address
Name
Title
Address
City
State
Zip Code
Home Phone
Home Fax
Beeper
Cell/Mobile Phone
E-Mail
Voice Mail
Corporate/Regional Company Address
Company
Specialty
Address
City
State
Zip
Phone
Fax
Case Management
Manager/Supervisor Home Address
Name
Title
Address
City
State
Zip
Home Phone
Home Fax
Beeper/Cell
Voice Mail
I have been oriented to and understand the new Vanderbilt University Medical Center vendor visitation
procedures and I agree to market my service in accordance with these procedures.
Case Manager Signature
Vendor Liaison Signature
Date
VANDERBILT MEDICAL CENTER CONFIDENTIALITY AND ACCESS POLICY
As a business partner of VUMC you may see, hear, or have access to “confidential
information.” The purpose of this agreement is to help you understand your duty
regarding confidential information as described in this policy.
Measures must be taken so that all information captured, maintained, or utilized by
VUMC and any of its off-site subsidiaries and affiliates can only be accessed by
authorized users. VUMC has a legal and ethical responsibility to safeguard the privacy
of all patients and to protect the confidentiality of their health information and all other
types of confidential information. Patient information is confidential information
regardless of how it is obtained, stored, utilized, or disclosed.
As a business partner, you are required to conduct yourself in strict conformance to all
applicable laws and Vanderbilt University and VUMC policies governing confidential
information. Your principal obligations in this area are explained below. You are
required to read and to abide by these duties. The violation of any of these duties may
result in the revocation of your authorization to do business with VU or VUMC, and may
subject you to legal liability as well.
As a member of the Vanderbilt community, you may have access to and use
confidential information in any or all of the following categories:
•
Patient information (such as charts and other paper and electronic records,
demographic information, conversations, admission/discharge dates, names of
attending physicians, patient financial information, etc.);
•
Information pertaining to members of the Vanderbilt community (such as
salaries, employment records, student records, disciplinary actions, etc.);
•
Vanderbilt University and VUMC information (such as financial and statistical
records, strategic plans, internal reports, memos, contracts, peer review
information, communications, proprietary information including computer
programs, source code, proprietary technology, etc.); and
•
Third-party information (such as insurance, business contracts, vendor
proprietary information source code, proprietary technology, etc.).
Last Revised: 02/05/05
VUMC CONFIDENTIALITY AGREEMENT
As a condition of and in consideration of my use, access, and/or disclosure of confidential
information, I,
, understand and agree to
the confidentiality requirements outlined in this agreement.
I understand that these
confidentiality requirements and my responsibility to protect the security of information
apply to when I’m working from home or off-campus as well as at VUMC facilities.
1.
I will access, use, and disclose confidential information only as authorized and
necessary to perform my contracted duties for VUMC. This means, among other things,
that:
a)
I will not in any way access, use, divulge, copy, release, sell, loan, review, alter,
or destroy any confidential information except as properly and clearly authorized
within the scope of my job and as in accordance with all applicable Vanderbilt
policies and procedures and with all applicable laws;
b)
I will report to the Privacy office any individual’s or entity’s activities that I suspect
may compromise the confidentiality of confidential information as prescribed in
OP 10-40.01 "Confidentiality of Protected Patient Information”.
2.
I understand that it is my responsibility to be aware of VUMC privacy policies, and other
policies that specifically address the handling of confidential information and misconduct
that warrants immediate termination of my relationship with VU and VUMC. I have
reviewed and am familiar with these policies.
3.
I understand that any fraudulent application, violation of confidentiality or any violation of
the above provisions may result in disciplinary action, including loss of system and
information access privileges, as well as other appropriate disciplinary measures up to
and including termination of affiliation with VU and VUMC.
My signature below indicates that I have read, accept, and agree to abide by all of the
terms and conditions of this Agreement and agree to be bound by it.
Date:
Signature:
Print Name:
Company Name:
Company Address:
Phone / Pager:
Last Revised: 02/05/05