• I will not share my UserID and Password.
• I will keep my UserID secure and password secure, i.e. not accessible to anyone else.
• If my UserID or Password is compromised or lost I will immediately notify KINNEY by calling 1-518-371-0176 and emailing ksystems@kinneyassoc.com.
• When entering services on the KINNEY web site I will assure that no one is able to observe. I will make sure that my monitor is not viewable by others and will sign off when I am finished entering information.
• When entering and/or accessing information on the KINNEY web site I will comply with all federal and state regulations controlling its treatment and release. This includes, but is not limited to the Federal Education Rights to Privacy Act (FERPA) and the Health Insurance Portability and Accountability act of 1996 (HIPAA).
• I will immediately report to KINNEY if the security/confidentiality of my password is compromised in any way.
• I will not knowingly report false information or knowingly permit the reporting of inaccurate information with regard to Medicaid Services.
• I will verify the identity of all persons to whom I assign a UserID and Password.
• I will only assign a UserID and Password to persons who sign a Confidentiality Agreement form.

Print Name: ______________________________________

Signature: ________________________________________ Date: ___________

Signature of District's KINNEY Access/Security Manager:

________________________________________________ Date: ____________

User ID: ________________________ Password: ___________________