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Table of ContentsVendor Access Policy.................................................................................................................................. 3

Vendor Code Of Conduct............................................................................................................................ 7

Vendor Access Guidelines........................................................................................................................... 8

Vendor Identification Badges..................................................................................................................... 12

Vendor Identification Badge Requirements...............................................................................................13

Vendor Procedure for Restricted Patient Care Areas................................................................................14

Obtaining a Vendor Badge........................................................................................................................ 16

Vendor Representative Sign-In/Sign-Out Procedure.................................................................................17

Vendor Profile Record............................................................................................................................... 18

General Confidentiality Statement.............................................................................................................20

Vendor Gift Disclosure Form.....................................................................................................................21

Vendor Access Programs FAQs................................................................................................................22

MedStar Health Hospitals..........................................................................................................................23

Effective Date of this Version: 9/1/14 of 22

Vendor Access Policy

PurposeTo state MedStar Health’s specific rules for access and activities of all vendor representatives at MedStar Health patient care facilities.

PolicyAll vendor representatives doing business at a MedStar Health patient care facility will comply with the established access requirements and policies associated with providing products, services or equipment. Any product, service or equipment brought into a MedStar Health facility not meeting these requirements will be considered a donation to MedStar Health for which there will be no remuneration. Badges are not transferable and can be used only by the representative to whom they are issued.

ScopeThis policy applies to any vendor representative providing educational support, service, products, intraoperative blood salvage and/or equipment to any MedStar Health patient care facility. This policy does not apply to temporary clinical or physician staff, volunteers, construction workers.

Definitions1. Vendor Representatives:

Vendor representatives are personnel employed by any company from whom MedStar Health purchases or will purchase services, products and/or equipment.

2. Vendor Access Program Administrator: MedStar Health employee responsible for overall management of vendor access program.

3. Vendor Photo Identification Badge: Photo identification badges will be issued by MedStar Health Corporate Materials Management Department to representatives having repeat business at MedStar Health facilities. Requirements for these badges are listed in the Vendor Access Program packet.

4. 24-Hour Vendor Identification Badge: 24-hour badges will be issued at individual MedStar Health facilities for representatives needing access to a MedStar Health facility two or fewer times annually. Authorization by a MedStar Health department manager is required to enter patient care areas with a 24-hour badge.

5. Vendor Access Program PacketMedStar Health will provide online access to the requirements, forms, procedures and policies related to the vendor access program.

Responsibilities1. Vendor Program Administrator

1.1. Manage corporate vendor database or Business Outsourcing Partner

1.2. Provide Vendor Access Program Packets to any new vendor representative.

1.3. Communicate infractions of vendor policy to representative and their employer.

1.4. Communicate any infraction involving a breach of patient confidentiality to the Corporate Privacy Officer.

2. Department Directors at MedStar Health Facility


2.1. Communicate as needed with representatives and the program administrator.

2.2. Coordinate and manage meetings with vendors.

2.3. In conjunction with the Product Standardization and Pharmacy and Therapeutics Committees manage and facilitate product or equipment trials.

2.4. Provide information regarding infractions by vendor representative(s) to Program Administrator for appropriate documentation and action.

2.5. Communicate any infraction involving a breach of patient confidentiality to the Corporate Privacy Officer.

3. Hospital Departments-All Hospital Employees3.1. MedStar Health employees should meet with vendor representative only if they have a scheduled appointment.

3.2. All MedStar Health employees are responsible for identifying noncompliant vendor behavior and reporting this to their manager.

4. Vendor Representatives4.1. Complete all requirements as listed in the Vendor Access Information Packet. No vendor representative badges will be issued until documentation has been completed. The Packet includes:

4.1.1. Vendor Access Policy

4.1.2. Vendor Code of Conduct

4.1.3. Vendor Access Guidelines

4.1.4. Vendor Procedure for Restricted Patient Care Areas

4.1.5. Vendor Badging Procedure

4.1.6 Vendor Sign-in/Sign-out Procedure

4.1.7 Vendor Profile Record

4.1.8 Confidentiality Statement

4.1.9. Vendor Gift Disclosure Form

4.2. Display vendor representative identification badge at all times while in any MedStar Health facility.

4.3. Comply with all MedStar Health policies regarding patient safety, confidentiality, infection control and risk management.

ExceptionsThis policy does not apply to physician offices. Application to outpatient settings will be made by local administrators. Other exceptions may be made by authorized MedStar Health employees in emergent situations.

What Constitutes NoncomplianceNoncompliance includes but is not limited to violation of any of the requirements cited in the MedStar Health Vendor Access Information Packet:

Vendor Code of Conduct Vendor Access Guidelines Vendor Badge Procedure Vendor Sign-in/Sign-Out Procedure Confidentiality Statement


Vendor Gift Disclosure Form

Any violation of federal, state or other regulatory laws may lead to the termination of the contract or business relationship. MedStar Health may report these violations to the appropriate agency, which could lead to consequences under the appropriate law.

Explanations and Details/ExamplesBadges are valid for as long as services are authorized and requirements are met. The representative must submit documentation of compliance or surrender their badge to MedStar Health Corporate Materials Management. If an event occurs that is in violation of the badge requirements, it is the responsibility of the representative’s employer to notify Corporate Materials Management in writing. The badge must be surrendered. The company is required to surrender the badge on the transfer or termination of a representative.

1. Vendor Identification BadgePhoto identification badge will be issued by the MedStar Health Corporate Materials Management Department to representatives having business at MedStar Health patient care facilities. The badge color will denote the level of access allowed to the representative. The badge contains: the company name, vendor representative’s name, vendor representative identification number and picture. Badge colors reflect the following access levels:

1.1. Green Vendor Badge – Level I:

Allows access to non-patient care areas only, i.e. Lab area, offices, etc

1.2. Blue Vendor Badge – Level II:

Allows access to limited patient care areas, i.e. patient care units, Pharmacy

1.3. Red Vendor Badge – Level III:

Allows access to restricted patient care areas, i.e. Inpatient and Outpatient Perioperative units, Imaging Departments, Emergency Department, etc.

All access is limited to an appointment confirmed by an authorized MedStar Health Representative.

2. 24-Hour Vendor Identification BadgeBadge issued at individual MedStar Health patient care facilities for representatives who occasionally need access to a MedStar Health facility.

If a Representative needs access more than two times annually, they need to meet all of the requirements for a Vendor Representative Identification Badge.

24-hour badges can be obtained from the facility’s security department or desk.

Requirements and Guidelines for Implementing the PolicyCorporate Materials Management and Hospital Department Directors will be responsible for managing and enforcing the Vendor Representative Access Policy.

Guidelines for Vendor RepresentativesNo product, service, equipment, drug or information will be introduced to a MedStar Health facility until it has met all of the approval criteria from MedStar Health or other applicable government agencies.

No drug samples will be distributed in any MedStar Health facility without the approval of that facility's Director of Pharmacy.

Representatives will abide by all HIPAA regulations and restrictions regarding patient confidentiality.


In case of a lost badge, Corporate Materials Management must be notified by the representative within 24 hours. During non-business hours, hospital security may be notified.

Reference to Laws or Regulations of Outside BodiesHIPAA

Right to Change or Terminate PolicyProposed changes to this policy will be discussed with all affected parties at both MedStar Health entities and corporate levels of the organization.

The corporation’s policies are the purview of the Chief Executive Officer (CEO) and the CEO’s management team.

The CEO has the final sign-off authority on all corporate policies.


Vendor Code Of ConductMedStar Health requires all vendors to adhere to the MedStar Health Code of Conduct (see attachment) and related policies and procedures.

MedStar Health strives to exercise the highest standards of conduct in working with vendors. We expect that our vendors will also use these same high standards when conducting business with MedStar Health.

Vendors will keep patient and business information confidential. No vendor will seek the attention or time of MedStar personnel without an appointment. Vendors will not request anyone other than a designated member of Materials Management,

Perioperative Services, Facilities or Pharmacy Departments to sign any type of purchasing agreement or contract. Agreements or contracts signed by a non-authorized MedStar agent will be considered non-binding. No agreement will be deemed valid until all MedStar Health contract conditions are met.

All contract negotiations and interactions between MedStar Health and vendors/suppliers shall be conducted in a manner that avoids the violation of any law or regulation and the appearance of impropriety.

Vendors will observe the general hours of operation of each facility. Access shall be limited to 9:00 AM to 5:00 PM unless other arrangements have been made through Materials Management, Perioperative Services, Pharmacy or other involved department.

Vendors will not demonstrate any supplies, equipment or pharmaceuticals to staff on site without approval by that department manager.

On each visit, vendors will be required to register upon arrival and sign out upon departure at a designated site(s) in each facility. (See Vendor Representative Sign-in/Sign-out Procedure in Vendor Information Packet.) During the visit, representatives will be required to display the appropriate MedStar Health-issued photo ID or 24-hour badge.

Gifts or inducements of any kind are subject to the limitations of the MedStar Health Code of Conduct. Any violation could negatively impact future business. Violation of federal or state laws or other regulator agencies may result in MedStar Health reporting these violations to the appropriate agency.

Vendors not compliant with MedStar Health Corporate and Hospital policies, procedures, including, Department Dress Code, Fire and Safety, etc. and Code of Business Conduct will lose their opportunity to access MedStar Health facilities.

Signature Date

Print Name


Vendor Access GuidelinesMedStar Health views vendor representatives as partners in support of our mission to provide the highest quality patient care in the safest environment. Our staff recognizes vendor representatives as a key resource in supporting high quality, cost-effective solutions and technologies.

Supply Chain StrategyIn support of the MedStar Health’s “patient first” core philosophy, the supply chain strategy is to create an effective supply chain operating model that will produce sustainable cost reductions, support high customer service standards, consolidate the supply chain infrastructure and standardize business practices. Vendors are expected to be in compliance with all applicable laws and regulations.

Materials Management Goals of Service1. Provide optimum support to our caregivers by providing them with timely accessibility of

appropriate, clean, safe, user-friendly products, equipment, and services.2. Have a clear understanding of and maximum influence over all elements of supply chain cost.3. Maximize understanding of and support for current and emerging technology.4. Work with trading partners to enhance each other’s quality of service and cost profile.

Participation in the Vendor ProgramMedStar Health will institute specific vendor requirements to participate in MedStar Health’s Vendor Representative Program. Areas of access levels are:

Level I Access – Green Badge All non-patient care areas, i.e., Laboratory, offices, etc.

Level II Access – Blue Badge Inpatient and Outpatient Nursing units

Level III Access – Red Badge Inpatient and Outpatient Perioperative areas Labor and Delivery departments GI Endoscopy areas Cardiac Catheterization and EP labs All Imaging areas to include Interventional, Diagnostic and Nuclear Medicine Emergency departments

No vendor may access a patient care facility without making prior arrangements per MedStar Health’s Vendor Access Policy.

Visitation RulesAuthorized MedStar Health employees in emergent situations may grant exceptions.

Visitation to a MedStar Health facility is by invitation only and will require a scheduled appointment. Under no circumstances will a vendor representative be permitted to visit MedStar Health staff without a scheduled appointment.

All vendor representatives are required to register at the Security Department or desk prior to conducting business at MedStar Health. All vendor representatives are required to check out of the site on completion of business. See Sign-in/Sign-out Procedure.

After checking in, vendor representatives are authorized to visit only the areas designated by their badge for their scheduled appointment. Vendor representatives may be present in common areas of the


facilities; however, initiating unsolicited contact with clinicians or other employees is prohibited. At the completion of the scheduled appointment, vendor representatives are expected to leave the facility.

Vendor Identification Badges are not transferable. At no time may a representative allow the use of his/her badge by another individual. To do so will result in the loss of access to any MedStar Health facility.

Vendor representatives are prohibited from access to confidential patient or product information unless it has been authorized as part of the information needed to complete their project. Only vendor representatives with appropriate clearance (Red or Blue Badge) may visit patient care areas and only when an appointment has been scheduled.

Vendor representatives are required to wear a MedStar Health-issued Vendor Identification Badge at all times while in a MedStar Health facility.

Vendor Identification Badges do not grant permission to provide direct patient care or indicate that MedStar Health or its facilities have approved the representative to provide such care. Only individuals who have met all applicable MedStar Health/facility requirements regarding credentialing, clinical privileges and/or other qualifications are permitted to provide direct patient care. Vendor representatives who are present while patient care is being rendered must always follow the direction, when given, of the attending physician or other MedStar Health/facility clinician involved in the procedure.

Vendor representatives are prohibited from displaying company information or advertisements without prior permission from the appropriate facility leadership, i.e., the Director of Materials Management or Pharmacy.

Vendor representatives are not permitted to park in areas designated for patients. Representatives must park in designated visitor parking areas and pay the appropriate parking fees. Some facilities may have additional parking restrictions, which the representative should observe. Vehicles parked in unauthorized areas will be towed at the driver’s expense.

Product Standardization/UtilizationVendor representatives may only deliver or install products, equipment or services that have been pre-approved for use by MedStar Health authorized personnel as determined by the facility. Vendors will not encourage clinicians or hospital staff to bring in any product outside of the established MedStar Health product process. All purchases of products and services must be approved by appropriate department head, i.e., Materials Management, Pharmacy, Laboratory Department, and supported by a valid purchase order.

Products and equipment for all trials or evaluations will be provided to MedStar Health at no charge and supported with a “no charge” purchase order. If a patient charge is generated, a Purchase Order will be required.

Products, equipment, or services provided without prior approval or a valid purchase order will be considered a donation to MedStar Health or may be returned at the supplier’s expense.

EquipmentAll equipment coming into a MedStar Health patient care facility for demonstration, evaluation, clinical/workplace application or purchase must be inspected before delivery to a unit. Equipment categories and inspection departments are:

Patient care equipment inspected by Clinical Engineering Non-patient care equipment inspected by Facilities Management Computer equipment inspected by Information Services

Any questions concerning equipment should be directed to the involved department manager.

Prior to removal, any equipment that might contain patient information, e.g., computers, fax machines, must have the approval of Information Services.


Business StandardsGifts or gratuities of any kind are subject to the MedStar Health Code of Conduct and any violation of this could negatively impact future business, as well as, be subject to fines or imprisonment if in violation of federal, state or other laws. Vendors will promptly and accurately complete and return any annual (or other) disclosure form regarding compliance with these standards requested by MedStar Health or its facilities/hospitals.

ComplianceMedStar Health is committed to full compliance with all federal, state and local laws, and ordinances. It is MedStar Health’s expectation that their vendors will also be in compliance with all federal, state and local laws, and ordinances.

Environmental CommitmentMedStar Health strives to maintain an environment that is free from health and safety hazards. Vendor representatives are required to follow all of MedStar’s health and safety policies.

Vendors providing hazardous material to MedStar Health must provide Material Safety Data Sheets (MSDS) at the time of the materials delivery and must provide for appropriate hazardous waste disposal.

Equal OpportunityMedStar Health is committed to maintaining an efficient and productive work environment that is free from discrimination and harassment. Vendor representatives doing business with MedStar Health are required to conduct themselves in a manner that upholds this commitment.


InvoicesAll purchase order-related invoices and statements should be mailed to the following billing address:

MedStar Health/Accounts Payable

MedStar Franklin Square Medical Center – PO Box 44200MedStar Good Samaritan Hospital – PO Box 44260MedStar Georgetown University Hospital – PO Box 44500MedStar Harbor Hospital – PO Box 44550MedStar Union Memorial Hospital – PO Box 44560MedStar Washington Hospital Center – PO Box 43910MedStar Health Corporate – PO Box 44250MedStar Diversified Business – PO Box 44310

Baltimore, MD 21236

MedStar Health/Accounts Payable

MedStar National Rehabilitation Hospital102 Irving St. NWWashington, DC 20010

To be processed, all invoices must contain:

Company name Company division and Tax ID number Item description Item order number Cost/each Extended Cost MedStar Health-assigned PO

Inquiries or questions regarding invoices should be directed to the Accounts Payable Department at 410-933-2501 or faxed to 410-993-2357

QuestionsDirect all questions relating to procurement policy, purchase order management, or the vendor access policy to MedStar Health Corporate Materials Management at 410-933-8044.


Choose appropriate PO Box

Erin, Mike, Tony: Will vendors know what “Diversified” means? Should we list the business names there?

Vendor Identification BadgesMedStar Health-issued identification badges are to be worn by vendor representatives at all times while in MedStar Health patient care facilities.

Vendor Identification Badges will consist of two categories:

Vendor Photo Identification BadgeThe Corporate Materials Management Department will issue a Photo Identification Badge to vendor representatives who have met the necessary requirements. Vendor badges will display the company name, vendor representative’s name, vendor representative’s picture, and vendor representative’s identification number. These badges are required to access any MedStar Health patient care facility.

24-Hour Vendor Identification Badge24-Hour Vendor Badges will be available in Security within each MedStar Health acute care facility. Vendor representatives needing a 24-hour badge will be required to log in prior to receiving a badge and log out at the close of business. The 24-Hour Vendor Badge will serve as a pass for the time period of the scheduled appointment or work requirement, not to exceed 24 hours. If a representative requests a 24-hour badge more than two times annually, they will be required to fulfill all the requirements for a Vendor Identification Badge. Authorization by a MedStar Health manager is required to access patient care areas with a 24-hour badge.

Confidentiality Statement must be completed at time of sign-in at facility security desk.

Badge DisplayVendor Identification Badges must be prominently displayed by the representative, with the photo visible and above the waist, and will be worn at all times while in a patient care facility.

Lost BadgesLost badges must be reported to the Corporate Materials Management Office within 24 hours. If this occurs outside of normal business hours, hospital security may be notified. Corporate Materials Management will replace lost badges for a fee of $75.00 per badge.


Vendor Identification Badge RequirementsThe following requirements must be completed with appropriate documentation on file in the Corporate Materials Management Department prior to the issuance of a vendor representative identification badge for access to MedStar Health patient care facilities.

GREEN VENDOR BADGE

Level I Access

Non Patient Care Areas

BLUE VENDOR BADGE

Level II Access

Patient Care Areas

RED VENDOR BADGE

Level III Access

Restricted Patient Care Areas

Read and sign MedStar Health’s Vendor Code of Conduct



Provide documentation of substance abuse testing



Completed Vendor Profile Record



Provide documentation of criminal background check



Provide documentation of non-exclusion from participating in federal programs (OIG,GSA,SDN sanction list)

Provide documentation of non-exclusion from participating in federal programs (OIG,GSA, SDN sanction list)

Provide documentation of non-exclusion from participating in federal programs (OIG,GSA,SDN sanction list)

Provide documentation of TB test results – To be completed annually

Provide documentation of TB test results – To be completed annually

Provide documentation of measles/rubella immunization

Provide documentation of measles/rubella immunization

Provide documentation of chicken pox immunization

Provide documentation of chicken pox immunization

Provide documentation of aseptic technique education

Provide documentation of education/certification on service or equipment being provided



Confidentiality Statement Confidentiality Statement Confidentiality Statement

Gift Disclosure Statement Gift Disclosure Statement Gift Disclosure Statement

Provide Documentation of Flu confirmation – To be completed annually




Vendor Procedure for Restricted Patient Care AreasPurposeTo state MedStar Health’s specific rules for access and activities of all vendor representatives at MedStar Health patient care facilities related to restricted clinical areas defined as:

Perioperative areas GI Endoscopy areas Labor and Delivery, Nursery All Imaging areas to include Cath and EP labs and Nuclear Medicine

PolicyAll vendor representatives doing business at a MedStar Health patient care facility will comply with the established credentialing requirements and policies associated with product trials and procurement.

ProcedureUpon arrival, all vendor representatives must meet requirements set forth in the Vendor Access Policy.

Vendor Representatives in Restricted Patient Care AreaThe presence of vendor representatives as technical advisors in any clinical area must be requested by the physician, specialty coordinator or manager, and approved by the designated clinical representative. Patient authorization may be required for a vendor representative to be present.

A Vendor Identification Badge does not grant permission to provide direct patient care or indicate that MedStar Health or its facilities have approved the representative to provide such care. Only individuals who have met all applicable MedStar Health/facility requirements regarding credentialing, clinical privileges and/or other qualifications are permitted to provide direct patient care. Vendor representatives who are present while patient care is being rendered must always follow the direction, when given, of the attending physician or other MedStar Health/facility clinician involved in the procedure.

Vendor representatives are limited to the specific case(s) they have been requested to attend and are not to enter into any other procedure rooms where cases are being preformed. All other MedStar Health policies concerning the presence of vendors must be followed. If standing approval is needed, a written request from the surgeon, or chief of the clinical service, stating the reason for “standing approval” must be submitted to the facility of that clinical area. Once approved by the director, an annual re-approval will occur.

Vendor representatives are not permitted to approach other clinicians to sell or, in any other way, detail their products unless specifically requested to do so by the clinician. Vendors will not encourage clinicians or hospital staff to bring in any product outside of the established MedStar Health process.

Vendor representatives must use the appropriate billing form to document product or implant use and charges. The form should include patient name and number, item description, item number, quantity used, and cost per item and total cost. This form must be completed at the time of the procedure and given to the appropriate materials representative or charge nurse. If this does not occur, the product will not be invoiced and will be considered a donation to MedStar Health. The patient will not be charged for the product.

Loaner Instrument and/or Instrument SetsFor electively scheduled surgical cases, loaner instruments and or non-stocked implants must be received into the hospital BY 13:30 ON THE DAY PRIOR TO THE SCHEDULED OPERATIVE PROCEDURE WITH A COUNT/INVENTORY SHEET AND PRICING. If instruments are not received by this time, the case may be changed or cancelled by unit management.


Instruments must be brought to the hospital clean and free of debris.

Representative should pick up loaner instrument sets within 24 hours after the surgical procedure unless special arrangements have been made. The hospital is not responsible for instrumentation left more than 24 hours from the completion of the case.

New Products Any product, service or equipment brought into a MedStar Health facility not in compliance with the MedStar Health Product Review Process will be considered a donation to MedStar Health for which there will be no remuneration.

The only exception is in an emergent situation with the authorization of a MedStar Health manager.


Obtaining a Vendor BadgeVendor Identification Badge Email all information to [email protected]

Card Quest may be reached by phone at 813-288-0004.

When all requirements are complete, the representative will be notified of where and when to pick up their badge via email. A photo ID will be required for badge pick-up.

24-Hour Vendor Badges24-Hour Vendor Badges may be obtained from the Security Department or desk at the individual patient care facilities.

Vendor Identification Badge Vendor representatives may obtain Vendor Access Program information by visiting: MedStarHealth.org/VendorAccess


mailto:http://MedStarHealth.org/VendorAccess%20

Vendor Representative Sign-In/Sign-Out ProcedureAll vendors entering MedStar Health facilities will be required to sign in and sign out when entering and exiting the facility. The grid below outlines the appropriate sign-in and sign-out location at the respective facilities.

VENDOR PHOTO IDENTIFICATION BADGE – ALL LEVELS

24-HOUR VENDOR IDENTIFICATION BADGE

Hospital/Entity 9 a.m. – 5 p.m. Other Hours

MedStar Franklin Square Medical Center

Employee/HR Entrance Employee/HR Entrance

MedStar Good Samaritan Hospital

Hospital Main Entrance ER Entrance after 9:00 p.m.

MedStar Georgetown University Hospital

Gorman Bldg – Lower Level Gorman Bldg – Lower Level

MedStar Harbor Hospital Main Entrance,ER and Gruehn Bldg

ER Entrance after 9:00 p.m.

MedStar Montgomery Medical Center

Main Entrance – Security Desk ER Entrance after 8:00 p.m.

MedStar National Rehabilitation Network

Main Entrance – Security Desk Main Entrance – Security Desk

MedStar St. Mary’s Hospital Main Entrance – Security Desk ER Entrance after 8:00 p.m.

MedStar Southern Maryland Hospital Center

Main Entrance – Security Desk ER Entrance after 8:00 p.m.

MedStar Surgery Center Main Entrance Desk Main Entrance Desk

MedStar Union Memorial Hospital

Any Entrance ER Entrance after 8:00 p.m.

MedStar Washington Hospital Center

Security Operations CenterRM G-9

Security Operations CenterRM G-9

Additional Sign-In/Sign-Out ProceduresSome MedStar Health restricted areas, i.e., Pharmacy; Perioperative areas may require additional sign-in/sign-out procedures. Please check with the department you are visiting to confirm any additional requirements.


Vendor Profile Record

General Information

Full Name of Company Company Phone

Company Address

City, State, Zip

Supervisor’s Name Supervisor’s Phone

Local Representative Information

Full Name

Address

City, State, Zip

Email Address Phone

Badge Level Requested ___ Level I ___Level II ___Level III

Product Line or Service

Indicate specific product by name

My qualifications and specific training enable me to (select all that apply)

___Teach ___Demonstrate

___Equipment ___Prosthesis/Implants ___Products ___Instrumentation ___Services and Repairs ___Drugs

___Clinical Staff ___Department Management

___Physicians ___Technicians

My product(s) can be used in a patient procedure:

___With my assistance ___Without my assistance

I am qualified to teach and demonstrate this product(s) because I have had special training in its use (to include hazards). My training includes (credentials, specific training/education and dates completed. Please attach all certification documentation for review.

I HAVE READ, UNDERSTAND AND AGREE TO ALL THE INFORMATION IN THE VENDOR ACCESS INFORMATION PACKET.

Signature Date

Print Name


General Confidentiality StatementI understand and agree that as part of one or more work projects (the “Project”) performed on the premises of, or on behalf of, any MedStar Health entity, I may, both prior to, during, and after the Project, have access to, or come in contact with, Confidential Information.

I understand that Confidential Information includes, but is not limited to, any of the following information or materials owned by or in the possession of any MedStar Health entity or created or received in connection with the Project: All business, financial, strategic and operational information, personnel information, quality improvement information, utilization management information, risk management information, operational policies or procedures, patient data or information, medical records, promotional and marketing programs, business plans, product specifications, manufacturing processes and operations, information about techniques, analytical methodology, safety, testing data and results, future market and product plans, billing and financial data, computer passwords/access rights, trade secrets, ideas and any other information of a technical, scientific, or economic nature.

I understand that all Confidential Information obtained, received, reviewed or which I may have contact with relating to the Project, is confidential in nature. I further understand and agree that I shall, at all times, ensure the confidentiality of all Confidential Information I have contact with, and comply with all applicable laws, as well as maintain patient privacy. I further agree that I shall only review or access the materials and information necessary to fulfill my obligations in connection with the Project. I agree that my agents, subcontractors, or other third parties may receive Confidential Information in connection with the Project only if they agree to the same conditions and restrictions that apply to me and that I am responsible for obtaining such assurances. I agree that in the event I receive any legal process requesting that I reveal any Confidential Information, I shall inform an appropriate any MedStar Health entity representative and afford any MedStar Health entity with a reasonable opportunity to review the request and for any MedStar Health entity to seek to protect the Confidential Information.

I agree to inform appropriate representatives of any MedStar Health entity of any breach of confidentiality for which I become aware and to reduce the effect of such breach by retrieving any inappropriately disclosed Confidential Information and taking any other actions necessary to minimize the effect or damages of such disclosure or use of such Confidential Information. I understand and agree that these obligations shall remain effective before, during and after the conclusion of the Project.

Signature of Contractor Date

Print Name


Vendor Gift Disclosure FormI, _________________________________________________, an authorized representative of

______________________________________________ (company name), attest that during the time

period January 1, 20___ through December 31, 20___, Vendor provided only the gifts or other items of

value described in this form to MedStar Health, Inc. or any of its affiliates or any employees or

representatives of such entities. Please note that any item or service provided under the express terms of

a written contract between Vendor and MedStar Health or its affiliates need not be reported on this form.

None (check here): _____

The following gifts or other items of value (describe in reasonable detail, including date, to whom the

gift/item of value was provided and approximate value):

____________________________________________________________________________________

____________________________________________________________________________________

The signature below represents our attestation that no gifts or other items of value other than those described above were provided during this reporting period.

Signature and Title Date


Vendor Access Programs FAQsSEND NO ORGINAL DOCUMENTS—NO DOCUMENTS WILL BE RETURNED

1. How do I provide documentation of substance abuse testing?If you have had testing done in the past, as part of your company’s hiring practice, have your HR department or a senior employee in your company, document this on company letterhead. If you have never been tested, you can request your physician to write an order for it to be done. We request that the standard 1 0-panel test be performed by a NIDA/SAMSI certified lab. Once your physician receives theresults, he/she can document the testing on either MD letterhead or a prescription slip.

DO NOT SEND ACTUAL TEST RESULTS

2. How do I provide documentation of Measles/Rubella and Chicken Pox immunizations?You can have your physician document, on letterhead or a prescription slip, that you had the immunizations and/or the diseases as a child, OR your physician may require you to have blood tests (titers) done to validate immunity. In either case, your physician can document this for you.

3. How do I document having had a criminal background check?Check with your HR dept. or with a senior employee in your company. If it was done as part of the company hiring practice, they can document it on company letterhead. There is no time limit/restriction associated with this requirement. If you need to have a background check done, we request that the standard 7-year federal/state/county criminal check, OFAC, GSA/OIG/SND and Social Security Number checked done.

DO NOT SEND THE ACTUAL CRIMINAL BACKGROUND INFORMATION

4. How do I provide documentation of non-exclusion from participating in federal programs (OIG, GSA, SND sanction list)?See above #3

5. How do I document education/certification on service or equipment being provided?Based on the service you will be providing or the equipment/product(s) you represent, you need to validate that you have received appropriate training. On company letterhead, a senior employee or HR can validate training and/or you can submit proof (copies) of educational classes/seminars, etc.

6. How do I document aseptic technique training?Your company on company letterhead can document that you have had this training, or you can submit proof (copies) of educational classes/seminars, etc.

BADGES WILL NOT BE ISSUED UNTIL ALL DOCUMENTATION IS RECEIVED.


MedStar Health HospitalsCentral Maryland Region

MedStar Franklin Square Medical Center9000 Franklin Square DriveBaltimore, MD 21237

443-777-7000MedStarFranklin.org

MedStar Good Samaritan Hospital5601 Loch Raven BoulevardBaltimore, MD 21239

443-444-8000MedStarGoodSam.org

MedStar Harbor Hospital3001 South Hanover StreetBaltimore, MD 21225

410-350-3200MedStarHarbor.org

MedStar Union Memorial Hospital201 East University ParkwayBaltimore, MD 21218

410-554-2000MedStarUnionMemorial.org

Washington, DC, Region

MedStar Georgetown University Hospital3800 Reservoir Road, NWWashington, DC 20007

202-444-2000MedStarGeorgetown.org

MedStar Montgomery Medical Center18101 Prince Philip DriveOlney, MD 20832

301-774-8655MedStarMontgomery.org

MedStar National Rehabilitation Network102 Irving Street, NWWashington, DC 20010

2020-877-1000MedStarNRH.org

MedStar Southern Maryland Hospital Center7503 Surratts Road (on rt 5)Clinton, MD 20735

301-868-8000MedStarSouthernMaryland.org

MedStar St. Mary’s Hospital25500 Point Lookout RoadLeonardtown, MD 20650

310-475-8981MedStarStMarys.org

MedStar Washington Hospital Center110 Irving Street, NWWashington, DC 20010

202-877-7000MedStarWashington.org

To obtain your vendor access badge please click here.

https://cardquest.com/medstar-health-vendor-access-program-1.html


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