Portable Device and Media Control Tracking Log Pursuant to Health System Policy 900. 26



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Portable Device and Media Control Tracking Log

Pursuant to Health System Policy 900.26


This log is maintained for Business Unit: RESEA, Department ID: _____________________

Located at 350 Community Drive, Manhasset, NY 11030




Date

Type of Device

Does the Device contain PHI?

Name of Device

Name of Individual Removing Device

Purpose of Removal

Date and Time Taken Out

Date and Time Returned



































































































































































































































































































































































































































































































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