Social Security Numbers (SSNs): UNM ID Numbers (Banner IDs): Patient Name: Patient DOB: Patient Address: R Patient Payroll/Financial Information: W Patient Grades/ Advisement or Tutoring Records: Patient Health Information (MRN, Prescriptions, Patient Care/ Information: Patient Credit Card Information: (Please specify) Number of Records < 500 records created per R year? W 500 or more total records created per year? Location of Data Use Globally: R UNMH/HSC Campus Only: W Department or Specific Staff Only, Other: (Please specify) Agreement Do you have a sample vendor contract and/or statement of work? No: V Yes, please attach: BAA
R W Social Security Numbers (SSNs): UNM ID Numbers (Banner IDs): Patient Name: Patient DOB: Patient Address: Patient Payroll/Financial Information: Patient Grades/ Advisement or Tutoring Records: Patient Health Information (MRN, Prescriptions, Patient Care/ Information: Patient Credit Card Information: (Please specify) Number of Records R W < 500 records created per year? 500 or more total records created per year? Location of Data Use R W Globally: UNMH/HSC Campus Only: Department or Specific Staff Only, Other: (Please specify) Agreement Do you have a sample vendor contract and/or statement of work? V No: Yes, please attach: BAA
p392-cybersecurity-plan.docx