<p> PYXIS COMPUTER SECURITY AND USE STATEMENT</p><p>Employee Name______</p><p>I understand and agree that in the performance of my duties of UCSD Medical Center, I must hold information in confidence.</p><p>I understand that under existing California State Law any person who maliciously accesses, alters, deletes, damages, or destroys any computer system, network, computer program or data shall be guilty of a felony.</p><p>I understand that the use of another person’s computer security code or password, or delegation of my code to another person, would likely be considered False Representation.</p><p>I understand that if there has been no activity with my User ID for 60 days or more, my access to the Pyxis MedStation system may be terminated.</p><p>I agree to accurately input data into the MedStation for all medications withdrawn, loaded, refilled and inventoried by me, including the correct quantity of the medication.</p><p>I agree to identify and report any malfunctions of the Pyxis MedStation.</p><p>I agree to immediately report any discrepancies to my Charge Nurse and/or Nurse Manager.</p><p>I agree to report any unresolved discrepancies to the Pharmacy as required in the Controlled Drug Policies.</p><p>I am advised that failure to comply with these policies and regulations may result in disciplinary action, which could include release from employment. Violation of local, State of California, or United States Federal statutes may carry the additional consequence of prosecution under the law, where judicial action may result in specified fines or imprisonment, or both; plus the cost of litigation or the payment of damages, or both; or all.</p><p>------</p><p>This is to acknowledge the responsibilities associated with my PYXIS computer security code. I understand that my code constitutes my signature and I will be responsible for all entries made under my code.</p><p>Date______Signature______</p><p>0f82163ba3e42c978c7de3a47bf89ba7.doc 1/11/2005 jal Pyxis MEDSTATION Password Request Form</p><p>Access to the Pyxis MedStation is limited to licensed Medical Center staff. It is a two-part user identification scheme: a user ID and a confidential PASSWORD or BioID. To maintain confidentiality, as a first time user, you will be required to change your password. </p><p>1. Fill in your personal data below. 2. Read the acknowledgement below and sign if all is understood and agreed. 3. Have your supervisor sign and date the bottom. 4. Return this form to the Hillcrest Pharmacy, 8765, or the Thornton Pharmacy, 7765.</p><p>The pharmacy staff will then enter your user ID into the Pyxis system with the specific privileges stipulated by your supervisor.</p><p>My initial password must be immediately changed the first time I log-on to a Pyxis MedStation. Below is a my requested user ID for the Pyxis MedStation system. The initial password is “NEW”. I understand that in combination with my user ID, my PASSWORD or BIOID will be my electronic signature for all transactions within the Pyxis system. I understand that no retrievable record of my password exists. All of my transactions on the MedStation system will be permanently recorded with my User ID, time and date. These records will be maintained and archived as per the policies of this hospital, and available for inspection by the Drug Enforcement Agency (DEA) and the State Board of Pharmacy, as is done with a hand written documents and signatures for controlled substance records.</p><p>I also understand that to maintain the integrity of my electronic signature, I must not give this password to any other individual.</p><p>______Signature of Pyxis User Date</p><p>******************************************************************************************************************* User ID ______(10 characters max – we recommend using mainframe User ID) Initial Password N E W N E W Unit/ Location______</p><p>Check the privilege level to be assigned: ____ Student Nurse (no narcotic access) ____ Respiratory Therapist</p><p>____ ED Attending Physician ____ Other Physician (report/witness only)</p><p>____ Traveler RN on assignment with contract end date: ______</p><p>____ Registry RN, regular staffing (location & initial activation in pharmacy)</p><p>____ UCSD Per Diem RN </p><p>____ Career UCSD Registered Nurse ____ Charge Nurse (Temp User Creation)</p><p>____ Pharmacy Technician ____ Pharmacist</p><p>Authorized by: ______Phone:______</p><p>Printed name of Authorizing Individual:______</p><p>0f82163ba3e42c978c7de3a47bf89ba7.doc 1/11/2005 jal</p>