Portable Device and Media Control Tracking Log Pursuant to Health System Policy 900. 26
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Date and Time Returned
Portable Device
and Media Control Tracking Log
Pursuant to Health System Policy 900.26
This log is maintained for Business Unit: RESEA, Department ID: _____________________
Located at 350
Community Drive
, Manhasset, NY 11030
Date
Type
of Device
Does the Device contain PHI?
Name of Device
Name
of Individual Removing Device
Purpose
of Removal
Date
and Time Taken Out
Date
and Time Returned
Page __ of ___
Directory:
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2013
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