Confidentiality Agreement

Download a blank fillable Confidentiality Agreement in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Confidentiality Agreement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


Columbia University Medical Center
Confidentiality Agreement
As a faculty member, employee, student, affiliate, visitor or volunteer at Columbia University Medical Center
(CUMC) you may have access to what this Agreement refers to as "Confidential Information." The purpose
of this Agreement is to help you understand your duty regarding Confidential Information.
"Confidential information" includes information about patients, employees, or students or financial or other
business or academic information relating to Columbia University Medical Center. You may learn or have
access to confidential information through CUMC computer systems (which include but are not limited to
the clinical, human resources and financial information systems) NewYork-Presbyterian (NYP) Hospital
computer systems, through interactions with CUMC students, staff or other faculty, or through your treatment
of CUMC patients.
As an individual having access to confidential information, you are required to conduct yourself in strict
conformance with applicable laws and CUMC policies governing confidential information. As a condition of
your relationship to CUMC, you are required to acknowledge and abide by these duties. A violation of any of
these duties will subject you to discipline, which might include, but is not limited to, dismissal of your
relationship (faculty appointment, employment, student, consulting, etc.) with CUMC, in addition to legal
and/or financial liability.
I understand that I may have access to electronic, printed, or spoken confidential information, which may
include, but is not limited to, information relating to:
Patients - including Protected Heath Information (PHI), records, conversations, patient financial
information, etc.;
Employees - including salaries, employment records, disciplinary actions, etc.;
Students - including enrollment, grade and disciplinary information;
Research - including PHI created, collected, or used for research purposes;
CUMC - including but not limited to financial and statistical records, strategic plans, internal reports,
memos, peer review information, communications, proprietary computer programs, source code,
proprietary technology, etc.;
Third party information - including computer programs, client and vendor proprietary information,
source code, proprietary technology, etc.;
PHI and Personal Identifying Information (PII) used in other contexts.
Accordingly, as a condition of, and in consideration of my access to confidential information, I promise that:
1. I will use confidential information only as needed by me to perform my legitimate duties as defined by
my relationship (faculty, employment, student, visitor, consulting, etc.) with CUMC.
I will not access confidential information which I have no legitimate need to know.
I will not in any way divulge copy, release, alter, revise, or destroy any confidential information
except as properly authorized within the scope of my relationship with CUMC.
I will not misuse or carelessly handle confidential information.
I understand that it is my responsibility to assure that confidential information in my possession
is maintained in a physically secure environment.
2. I will safeguard and will not disclose to any other person my access code (password) or any other
authorization code that allows me access to confidential information. I will be responsible for misuse or
wrongful disclosure of confidential information that may arise from sharing access codes with another
person and/or for failure appropriately to safeguard my access code or other authorization to access
confidential information.


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Page of 2