Healthcare Cerner Direct Account

Healthcare Cerner Direct Account

Use this form to request issuance or modification of a Cerner Direct secure messaging account for clinical and administrative exchange of protected health information (PHI). Complete all fields accurately. The applicant certifies acceptance of the responsibilities, conditions, and privacy obligations set forth below.

Organization / Facility Information

Requestor / User Information

Direct Address & Certificate

Certificate management: choose whether the organization will manage the certificate or the user will provide a PKI certificate. If providing a certificate, include certificate subject or thumbprint below.

Account Access & Configuration

Purpose, Use, and Compliance

This Cerner Direct account will be used solely for authorized exchange of PHI in support of treatment, care coordination, public health reporting, or other permitted healthcare operations. All use must comply with applicable state and federal privacy and security laws, organizational policies, and Cerner Direct technical requirements. Unauthorized use, disclosure, or disclosure of private keys is prohibited and may result in account suspension or termination.

Responsibilities & Conditions

By requesting this account, the applicant certifies the following obligations, which are conditions of account issuance: maintain confidentiality of private keys and credentials; report suspected compromise of credentials or certificate immediately and no later than 24 hours to the facility security officer; use the account only for authorized healthcare activities; not forward encrypted PHI to unauthorized recipients; and return or revoke access upon termination of employment or role change.

HIPAA & Privacy Acknowledgment

The applicant affirms that use of this Direct messaging account will conform to HIPAA privacy and security standards and applicable state law. PHI transmitted via Direct must be limited to the minimum necessary and only to authorized recipients. Misuse may result in disciplinary action, civil liability, or criminal penalties as provided by law.

Authorization & Administrative Use

The organization retains the right to audit messages, revoke access, and require configuration changes to comply with technical and policy requirements. The organization may suspend or terminate accounts for noncompliance or security concerns. The applicant authorizes the organization to issue and manage certificates as indicated.

Additional Information

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