Forms

This section of the site outlines the different types of forms made available by the Dubuque Internal Medicine Technology Team.

Forms:
Information Confidentiality/Security Agreement – In order to access any ePHI at Dubuque Internal Medicine, you must complete this form.

Remote Access/Security Request – This form has been made available for non-DIM users. In the event a non-DIM user needs to access ePHI information housed at Dubuque Internal Medicine, they will need to complete and fax this form.

Remote Novarad PACS Access/Security Request – This has been made available for non-DIM users. In the event a non-DIM user needs to access the DIM Novarad PACs system, they will need to complete and fax this form.