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Michigan Care Improvement Registry (MCIR) Dispensing Pharmacist User/Usage (Michigan Care Improvement Registry)

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Michigan Care Improvement Registry (MCIR)
Dispensing Pharmacist User/Usage Agreement
In accordance with Public Act 540 of the Public Acts of 1996, Amended 2006 as Act 91, and codified as MCL 333.9201 et seq. of the Michigan Public Health Code, the
Michigan Department of Health and Human Services (MDHHS) has established the Michigan Care Improvement Registry (MCIR) to record information regarding
immunizations administered by health care providers. Access to the MCIR is permitted for the sole purpose of providing information and documentation needed for
immunization purposes. Users of the system must refrain from employing the MCIR and data on the MCIR for any use other than that required to provide immunization
services. Access to the MCIR database is permitted under the provisions of MCL 333.9201, 9204, 9206, 9207 and 9227. Access to MCIR data is under the terms and
conditions prescribed by the MDHHS. Improper use of the MCIR will result in revocation of the user’s access privileges and potential liability under MCIR, Vital Records,
and Michigan Computer Crime Laws. The MDHHS reserves the right to revoke a user’s access privileges at any time, without notice.
A pharmacist, defined as an individual licensed under Article 15 to engage in the practice of pharmacy (as defined in Public Health Code MCL 333.17707) may use this form to
register to use the MCIR. Please read the following statements. If you agree to abide by these statements, please complete the information requested below and return this
agreement to:
The appropriate Regional MCIR Office (visit http://www.mcir.org/contact_regions.html for contact information).
As a user of the
Michigan Care Immunization Registry I accept and agree to the following:
3 I will handle information or documents obtained through the MCIR in a confidential manner.
3 I will restrict my use of the MCIR to access information and to generate documents only as necessary to properly conduct the administration and
management of my duties as they relate to immunizations.
3 I understand that my transactions on the MCIR are logged and are subject to audit.
3 I will not furnish information or documentation obtained through the MCIR to individuals for their personal use nor to any individuals not directly
involved with the conduct of my duties as they relate to immunizations.
3 I will not alter or falsify any document or data obtained through the MCIR.
3 I will not attempt to copy all or part of the database or the software used to access the MCIR database in any unauthorized fashion, nor attempt to falsify
or otherwise alter data in the MCIR database or otherwise violate the Michigan Computer Crime Law (MCL 752.794 - 752.797)) or the Vital Records
Law (MCL 333.2894) summarized on the reverse side of this form.
3 I will carefully safeguard my access privileges and password for the MCIR and I will not permit the use of my access privileges or password by any
other person.
3 I will report any threat to or violation of the MCIR security.
3 I will timely and accurately enter data (or ensure that information is timely provided for entry) into the MCIR regarding pharmaceuticals dispensed.
3 I will strive to enter accurate and timely data into the MCIR.
3 Data contained in the MCIR may not be used for research purposes without approval by the MDCH Institutional Review Board
(www.michigan.gov/irb). Refer to Admin Rule R 325.9055
Provider Information (Please print or type):
Please select one of the following three options and complete the
Form below:
I would like to be granted access rights to MCIR.
I would like to renew my access rights to MCIR (Every three years a renewal MCIR application must be submitted to the MCIR regional office)
I would like to change information in my existing MCIR User/Usage Agreement. Please enter your SITE NUMBER: ______________________________
I would like to discontinue use of my MCIR SITE. Please enter your SITE NUMBER: ______________________________
I would like to merge my SITE NUMBER: __________________________ with this SITE NUMBER: __________________________________
I am registering as a (Check One): Licensed Pharmacist
I am registering as a (Check One): Other: (s
pecify) ___________________
I am registering as a/an:
Site Administrator
I have read the above security agreement and the prohibited acts provided on the reverse side of this form. I understand this
information and I agree to comply with the above provisions. Further, I understand any violation of these provisions may result in
termination of access privileges and/or recommendation for prosecution.
Please complete the following information: PLEASE PRINT or TYPE
Applicant’s Full Name
Pharmacy Name Pharmacist License #:
Facility Address:
Street City State Zip Code County
Phone #: / Fax #: /
(REQUIRED) Applicant’s E-Mail Address:
Pharmacist Signature Date Signed:
7/1/2015 - Fill pdf-8.26.2019
3/1/2011
Prohibited Acts
Michigan Care Improvement Registry Law
MCL 333.9201, 333.9206, 333.9207, 333.9227
Sec. 9206(2) Before administering an immunizing agent to a child, a health care provider shall notify the parent, guardian or person in
loco parentis of the child, on a form provided by the department, of the right to object to the reporting requirement of
subsection(3).
Sec 9206(3) Unless the parent, guardian or person in loco parentis of the child who received the immunizing agent objects by written
notice received by the health care provider prior to reporting, a health care provider shall report to the department each
immunization administered by the health care provider, pursuant to rules promulgated under section 9227. If the parent,
guardian or person in loco parentis of the child who was immunized objects to the reporting requirement of this subsection
by written notice received by the health care provider prior to notification, the health care provider shall not report the
immunization.
Sec 9207(2) The information contained in the registry is subject to the confidentiality and disclosure requirements of sections 2637 and
2888 and to the rules promulgated under section 9227. The department may access the information contained in the registry
when necessary to fulfill its duties under this code.
Vital Records Law
MCL 333.2894 (1) A person shall not:
(d) Willfully and knowingly obtain, possess, use, sell, furnish, or attempt to obtain, possess, use, sell, or furnish to another
person, for any purpose of deception, a counterfeited, altered, amended, or mutilated vital record or certified copy
thereof.
(e) Willfully and knowingly furnish or process a vital record or a certified copy of a vital record with the knowledge or
intention that it be used for the purposes of deception.
(2) A person shall not make, counterfeit, alter, amend, or mutilate a vital record or report required to be filed under this
part with the intent to deceive.
MCL 333.2898 A person who violates section 2894...is guilty of a misdemeanor punishable by imprisonment for not more than 1 year, or a
fine of not more than $1,000.00, or both.
Michigan Computer Crime Law
MCL 752.794 - 752.797
Sec.752.794 A person shall not intentionally access or cause access to be made to a computer program, computer, computer system, or
computer network to devise or execute a scheme or artifice with the intent to defraud or to obtain money, property, or a
service by a false or fraudulent pretense, representation, or promise.
Sec 752.795 A person shall not intentionally and without authorization or by exceeding valid authorization . . . (a) Access or cause
access to be made to a computer program, computer, computer system, or computer network to acquire, alter, damage,
delete, or destroy property or otherwise use the service of a computer program, computer, computer system, or computer
network.
Sec 752.795a A violation of the Michigan children's protection registry act is a violation of this act.
Sec 752.796 (1) A person shall not use a computer program, computer, computer system, or computer network to commit, attempt to
commit, conspire to commit, or solicit another person to commit a crime.
7/1/2015
(2) This section does not prohibit a person from being charged with, convicted of, or punished for any other violation of
law committed by that person while violating or attempting to violate this section, including the underlying offense.
(3) This section applies regardless of whether the person is convicted of committing, attempting to commit, conspiring to
commit, or soliciting another person to commit the underlying offense.
752.796a (1) A person who violates section 5a is guilty of the following:
(a) For the first violation, a misdemeanor punishable by imprisonment for not more than 1 year or a fine of not more than
$10,000.00, or both.
(b) For the second violation, a felony punishable by imprisonment for not more than 2 years or a fine of not more than
$20,000.00, or both.
(c) For the third and any subsequent violation, a felony punishable by imprisonment for not more than 3 years or a fine of
not more than $30,000.00, or both.
(2) A person does not violate section 5a because the person is an intermediary between the sender and recipient in the
transmission of an electronic message that violates section 5a or unknowingly provides transmission of electronic messages
over the person's computer network or facilities that violate section 5a.
(3) It is a defense to an action brought under this section that the communication was transmitted accidentally. The burden
of proving that the communication was transmitted accidentally is on the sender.
(4) This section does not take effect until July 1, 2005.
752.796b All money and other income, including all proceeds earned but not yet received by a defendant from a third party as a result
of the defendant's violations of this act, and all computer equipment, all computer software, and all personal property used
in connection with any violation of this act known by the owner to have been used in violation of this act are subject to
lawful seizure and forfeiture in the same manner as provided under sections 4701 to 4709 of the revised judicature act of
1961, 1961 PA 236, MCL 600.4701 to 600.4709.
Sec 752.797 A person who violates this Act, if the violation involves less than $200.00, is guilty of a misdemeanor. If the violation
involves $200.00 or more, the person is guilty of a felony, punishable by imprisonment, or a fine or both.
This document is subject to revision or withdrawal at any time at the discretion of the Michigan Department of Health and Human Services
7/1/2015
Instructions for Completing the MCIR Provider User/Usage Agreement
You must complete this agreement and submit it to your Regional Coordinator for approval before gaining access to
the Michigan Care Improvement Registry (MCIR). Follow the instructions below to complete the MCIR Provider
User/Usage Agreement.
Step One: Read the Agreement
Carefully read the first two paragraphs of this a
greement, including the bulleted list of statements at the top of the
form, so that you completely understand the confidentiality regulations, restrictions, and requirements for using the
MCIR. Complete text for the laws, acts, and provisions cited in these passages is included with this agreement for
your reference.
Step Two: Select one of the three options which define your intent for using this Form
1. You may request access to MCIR.
2. You must renew your MCIR access rights every three years according to MCIR legislation. A new user
agreement
must be submitted to the MCIR regional office.
3. You may change information you submitted on your previous M
CIR User/Usage Agreement. You will
need to enter your current SITE ID here, as well.
4. You may request to have your site disabled. You will need to enter your current SITE ID on the form.
The SITE ID i
s located under My Site tab.
Then proceed to Edit My Site link. SITE ID is located in the top
right corner of the page.
5. You may request to have a MCIR SITE ID merged with another MCIR SITE ID (exam
ple clinic merger,
retired physician)
Step Three: Register as a Public or Private Provider
Under the Provider Information hea
ding, specify whether you are registering as a public or private provider:
3 Check Pu
blic Provider if you are primarily employed by a public health department; or
3 Check Private Provider
if you are primarily employed within the private sector.
You may check only one option.
Step Four: Register as a Specialty Designation
Specify the specialty designation under which you are registering.
The choices are: (You may check only one of
these options.)
Pharmacist
Other
(please specify in the space provided).
Site
Administrator: Staff person who is responsible for registering and monitor MCIR User accounts for the
organization.
Step Five: Entering Site Demographic Data
Applicant’s Name:
Pharmacist to dispense immunizing agent(s).
Organization:
Pharmacy Name
Enter Organization/Pharmacy Name as well as the full name and title of the designated pharmacist on the lines
provided.
Step Six: Sign and Deliver the Agreement:
The pharmacist specified in Step 5 should sign and date this agreement
and send it to the address identified in
paragraph two of the MCIR Provider User/Usage Agreement. Any issues or questions regarding confidentiality or
the appropriate use of the MCIR by the members or staff of the registered organization or practice are the
responsibility of the pharmacist specified in Step 5.
This document is subject to revision or withdrawal at any time at the discretion of the Michigan Department of Health and Human Services.
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Completed 3 June 2021

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