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Access to SCCA and PHI

If you require access to an SCCA building, network access AND access to confidential patient health information to perform your job related duties, the Non-Employee Paperwork Packet along with the UWMC Applications form must be completed.

Please have all paperwork submitted at least two weeks prior to your start date.

Procedure:

I. Schedule a time to meet with the Human Resource Department in the FHCRC Yale Building to complete your required SCCA non-employee paperwork at:                                      

Human Resource Administration
823 Yale Ave. N. J1-105
escmail@fhcrc.org
phone: 206-667-4700
fax: 206-667-4051

Non-Employee Staff Paperwork includes:

  1. HR Non-Employee Action Form (PDF)
    • This form must be filled out by your direct Supervisor and signed by your SCCA Manager or an approved SCCA Sponsor.  Please refer to the approved sponsor list (PDF) for more information on who should sign your form.
    • If you will require network access (O:/J:/H:/ Drives) and/or email access to perform your job duties be sure to check those items under the heading “Please check any required SCCA items for this non-employee“. If you will not be using the SCCA network please do not select any boxes related to network account or email activation.
  2. SCCA Confidentiality Policy Agreement
  3. Photo ID
  4. Key Card (only if required to perform your job duties)
  5. Criminal History Information Form
  6. Disclosure and Authorization to Obtain Information
  7. Immunization Health History
  8. Harassment in the Workplace
  9. Review and attestation of the Integrity at Work booklet
  10. Review of Patient Rights and Responsibilities
  11. Information Packet Forms Agreement
  12. Self Guided Orientation Packet

II. Complete the online UWMC Applications form.

  1. The web form must be completed by your direct Supervisor.
  2. The form must then be electronically submitted to the UAA.

PLEASE NOTE:

Your request for UWMC Applications will not be submitted until you officially receive SCCA non-employee status from the Human Resource Department.

For questions or concerns about SCCA’s Non-Employee Affiliate process please contact the privacy office at 288-6266 or privacy@seattlecca.org

For questions about affiliate paperwork, timelines, and status contact the Human Resource Department at 667-4700 or esmail@fhcrc.org
 

08-13-2008   SCCA Final Sponsor List (19kb)

08-13-2008   Non-Employee Action Form (37kb)