As an employee of
OR as an employee of a contractor of
I will be allowed to access CHIA-INET, the data reporting system provided to
by the Center for Health Information and Analysis
subject to the following terms and conditions:
• I will not disclose my CHIA-INET user ID and password to any other person.
• I will not attempt to access or look at CHIA-INET data other than what is required to perform my job.
• I will use any data I receive from CHIA-INET only as permitted and only in furtherance of my job.
• I will not share any data I receive from CHIA-INET with others unless doing so is necessary to do my job
(pertains to patient level condential data only).
• I will discuss data I receive from CHIA-INET with others only as required to perform my job and will conduct
such conversations only in secure areas where I am unlikely to be overheard (pertains to patient level condential data only).
• I will not disclose any data that I receive from CHIA-INET to any third party unless I have specic written
permission from my supervisor or the legal order of a court (pertains to patient level condential data only).
• I hereby acknowledge I have read the above terms and conditions and agree to be bound thereby as a condition of access
to and use of CHIA-INET.
CHIA INET USER AGREEMENT
REQUIRED INFORMATION – please print and no abbreviations
Company Name and Department:
Work Mailing Address:
User Signature: Date:
(Please provide middle name initial)
(Required to send User ID and Password information)
Provider User Agreement - Page 1 of 2
MassHealth Provider ID# with Location. This consists of 9 numbers
for the Provider ID# and 1 Letter for the Location (i.e. 123456789A)
(if more than one entity is applicable please attach and submit a list of all entities, including the entity’s MassHealth Provider ID, with this Agreement)
(if more than one entity is applicable please attach and submit a list of all entities, including the entity’s
MassHealth Provider ID, with this Agreement)
click to sign
click to edit