Title Page
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Conducted on
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Prepared by
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Location
Technology
Devices (computers, printers, iPads, etc)
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Are devices in good working order?
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If any device is less than in GOOD working order, record details.
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Are devices free of visual damage?
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If any device has any damage, record details.
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Are devices compliant with HIPAA password storage guidelines? (no sticky notes with passwords, etc)
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If yes, record details.
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Do devices match Asset Guard information?
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If no, record details.
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Has all information been updated in Asset Guard for this date’s inspection?
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If no, record details.
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Are devices stored in a secure location when not in use?
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Record details. Include storage location and if location is locked?
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Do all devices have chargers?
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If no, record details.
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Do all devices hold a charge adequately?
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If no, record details.
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Have all needs for devices been met on this visit?
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If no, what needs are being addressed?
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Do all devices stay at facility at all times? (Employees should not be removing devices from facility at any times)
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If no, does employee have written approval to remove device from facility? (Attach documentation)
Physical Assesment
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Are all rehabilitation department areas secure when not in use?
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How are areas secured?
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Is there printed or written PHI in the department areas?
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If yes, describe what manner of PHI?
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Is printed or written PHI the minimum necessary to fulfill job requirements?
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If no, record details.
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Is PHI secured properly?
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If no, record details.
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Does all written and printed PHI remain at the facility at all times?
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If no, record details.
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