CONFIDENTIALITY AND SECURITY

AGREEMENT
I understand that Woods & Water Medical Center in which or for whom I work, volunteer,
receive student training, or provide services, or with whom the entity (e.g. physician practice) for
which I work has a relationship (contractual or otherwise) involving the exchange of health
information (Woods & Water Medical Center), has a legal and ethical responsibility to safeguard
the privacy of all patients and to protect the confidentiality of their patients health information.
Additionally, Woods & Water Medical Center must assure the confidentiality of its human
resources, payroll, fiscal, research, internal reporting, strategic planning, communications,
computer systems and management information (collectively, with patient identifiable health
information, Confidential information).
In the course of my employment/assignment/student training at Woods & Water Medical Center,
I understand that I may come into the possession of this type of Confidential Information. I will
access and use this information only when it is necessary to perform my job related duties in
accordance with Woods & Water Medical Centers Privacy and Security Policies available on
Woods & Water Medical Centers information systems. I further understand that I must read,
sign, and comply with this Agreement in order to obtain authorization for access to Confidential
Information.
1.

I will not disclose or discuss any

Confidential Information with others,
including friends or family, who do not have
a need to know it.

2.

I will not discuss Confidential Information

where others can overhear the conversation.
It is not acceptable to discuss Confidential
Information even if the patients name is not
used.

3.

I understand that I must safeguard and

maintain the confidentiality, integrity, and
availability of all Confidential Information I
use, disclose, and/or access at all times,
whether or not I am at work and regardless
of how it was accessed.

4.

I will only access, use, and/or disclose the

minimum necessary Confidential
Information needed to perform my assigned
duties and disclose it to other
individuals/organizations who need it to
perform their assigned duties or as allowed
by law.

5.

I will not access my own or my familys

medical records in any information system

without prior Authorization from the HIM

Manager (unless required to perform you job
duties.
6.

I will not make any unauthorized

transmissions, inquiries, modifications, or
purging of Confidential Information.
Furthermore, I will not download and
Confidential Information off Woods &
Water Medical Centers system or disc, zip
discs, flash drives, other portable media, etc.
except in situations where explicit approval
to do so has been granted by the IT
department with prior review by the Security
& Privacy Officer. If I received this approval
to download data I will assume sole and
absolute responsibility to manage and
protect it based upon standards listed in the
Agreement and according to the law.

7.

I will not in any way divulge copy, release,

sell, loan, alter, or destroy and Confidential
Information except as properly authorized.

8.

I agree that my obligations under this

Agreement will continue after my
termination of my employment, expiration

of my contract, or my relationship ceases

with Woods & Water Medical Center.
9.

10.

11.

12.

16.

Upon termination, I will immediately return

any documents or media containing
Confidential Information to Woods & Water
Medical Center.
I understand that I have no right to any
ownership interest in any information
accessed or created by me during my
relationship with Woods & Water Medical
Center.
I will act in the best interest of Woods &
Water Medical Center and in accordance
with its Code of Ethics at all times during
my relationship with Woods & Water
Medical Center.
I understand that violation of the Agreement
may result in disciplinary action, up to and
including termination of employment,
suspension and loss of privileges, and/or
termination of authorization to work within
Woods & Water Medical Center, in
accordance with Woods & Water Medical
Centers policies.

13.

I will only access or use systems or devices

that I am officially authorized to access, and
will not demonstrate the operation or
function of systems or devices to
unauthorized individuals.

14.

I will practice good workstation security

measures such as locking up diskette when
not in use, using screen savers with activated
passwords appropriately, and position
screens away from public view.

15.

I will practice secure electronic

communications by transmitting
Confidential Information only to authorized
entities, in accordance with approved
security standards.
I will:

a. Use only my officially assigned User-ID and

password.
b. Use only approved licensed software.
17.

I will never:
a. Share/disclose User-Ids and passwords.
b. Use tools or techniques to break/exploit
security measures.
c. Connect to unauthorized networks through the
systems or devices.

18.

I will notify my manager or IT if my password

has been seen, disclosed, or otherwise
compromised, and will report activity that
violates this Agreement, privacy and security
policies, or any other incident that could have any
adverse impact on Confidential Information.

19.

I have received training on how to protect health

information/confidentiality as necessary and
appropriate to perform my job responsibilities.

20.

I understand that I will be held accountable for all

inquiries, entries, and changes made to any of
Woods & Water Medical Centers information
systems using my User name(s) and password(s).

Refer any questions related to this Agreement to the Security Officer or Privacy Officer.
By signing this Agreement, I agree to comply with its terms and conditions. Failure to read
this Agreement is not an excuse for violating it. The IT department may deny access to
Woods & Water Medical Centers information systems if this Agreement is not returned
signed and dated.

Employee Signature

Employee Printed Name

Return this completed from to Human Resources
4/16/15

Date