As a health care professional who treats patients and residents of facilities (hereafter referred to as“Health Care Professional”), you may have access to “confidential information.” The purpose of thisthe agreement is to confirm your understanding of and obtain your commitment to your duties regardingconfidential information.
Confidential information is valuable, sensitive, and protected by law and facility policies. As a HealthCare Professional, you must conduct yourself in strict conformance to applicable laws and the facilitypolicies and to abide by the duties described below governing confidential information.You will be responsible for any alteration, destruction, misuse, or wrongful disclosure of confidentialmedical information by you and for any failure by you to safeguard any authorization codes to accessconfidential information. You understand that your failure to comply with the duties described below andthis agreement may also result in loss of privileges to access confidential information, loss of privileges totreat patients and residents at facilities and to legal liability.
As a Health Care Professional, you understand that you will have access to such confidential medicalinformation that may include, but is not limited to, information relating to:
Patients and residents (such as medical records, private conversations, admittance information, residentfinancial information, etc.)
• Other contractors (such as salaries, employment records, disciplinary actions, etc.)• Facility information (such as financial and statistical records, strategic plans, internal reports,memos, contracts, peer review information, communications, proprietary computer programs,source code, proprietary technology, etc.)• Third party information (such as computer software programs, client and vendor proprietaryinformation, proprietary technology, etc.).
As a condition of and in consideration of your access to such confidential information, you promise that:1. You will use confidential information only as needed to perform your legitimate duties atfacilities.a. You will only access confidential information needed to treat your patients and residentsor fulfill your responsibilities.b. You will not in any way divulge, copy, release, sell, loan, review, alter, or destroy anyconfidential information except as properly authorized within the scope of yourprofessional activities as a Health Care Professional and treater of residents affiliatedwith facilities.c. You will not misuse or fail to safeguard confidential information.2. You will safeguard and will not disclose any authorization codes or keys you have that allow youto access confidential information. You accept responsibility for all activities undertaken usingyour authorization codes or keys.3. You will report to the Facility Privacy Officer activities by any individual or entity you suspectmay compromise the confidentiality of confidential information described in this agreement.4. You understand that your obligations under this agreement will continue after the termination of yourprivileges or permission to treat patients and residents of facilities. You understand that facilities Download Adobe Reader toFill and Sign ApplicationFax application to 1-877-337-4879 Email to firstname.lastname@example.org review, revise or terminate your privileges to access and use confidential information asreasonably warranted to protect the confidentiality of such information.5. You understand that you have no right to an ownership interest in any confidential informationreferred to in this agreement. The facility may at any time revoke your key, access code, otherauthorization, or access to confidential information.6. Health Care Professional shall indemnify and hold facilities harmless from and against all claims,liabilities, judgments, fines, assessments, penalties, awards, or other expenses, of any kind ornature whatsoever. This indemnification includes without limitation, attorneys’ fees, expertwitness fees, and costs of investigation, litigation, or dispute resolution, relating to or arising outof any breach or alleged breach of this agreement by Health Care Professional.7. You will respect the ownership of proprietary software.8. You will not operate any non-licensed software on any computer provided by any facility.By signing this, I agree that I have read, understand, and will comply with this agreement.