HIPAA Compliancy Device Registration

As part of our HIPAA Compliancy we are required to register all devices that are used to access Wellness Counseling Center information and used to communicate with Wellness client.

Please complete the form below.

HIPAA Compliancy Device Registrations

Name

LAPTOP

Type (Check all that apply)
Is this device encrypted?
Does this device have a strong password?
Does this device have anti-virus/malware protection?

DESKTOP

Type (Check all that apply)
Is this device encrypted?
Does this device have a strong password?
Does this device have anti-virus/malware protection?

TABLET

Type (Check all that apply)
Is this device encrypted?
Does this device have a strong password?
Does this device have anti-virus/malware protection?

What type of cell phone do you use?

Check all that apply(Required)