Fillable Confidentiality Agreement (Page 2 of 2) in pdf

Confidentiality Agreement

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I will log off computer systems after use.

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I will not log on to a system or access confidential information to allow another person access to

that information or to use that system.

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I will report any suspicion or knowledge that my access code, authorization, or any confidential

information has been misused or disclosed without CUMC authorization.

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I will not download or transfer computer files containing confidential information to any non-

NYP/CUMC authorized computer, data storage device, portable device, telephone, or other

device capable of storing digitized data.

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I will only print documents containing confidential information in a physically secure

environment, will not allow other persons’ access to printed confidential information, will store

all printed confidential information in a physically secure environment, and will destroy all

printed confidential information when my legitimate need for that information ends in a way that

protects the confidentiality of the information.

3. I will follow CUMC policies and procedures regarding the use of any portable devices that may contain

confidential information including the use of encryption or other equivalent method of protection.

4. I acknowledge my obligation to report to the CUMC Privacy Officer any practice by another person that

violates these obligations or puts CUMC, its personnel, or its patients at risk of a disclosure of

confidential information.

5. I will only use my Columbia email account to send and receive message that may include

confidential information and will not use email to send confidential information to other parties outside of

Columbia/NYP without protection to prevent unauthorized access.

6. If I am involved in research, any research utilizing individually identifiable protected health information

will be performed in accordance with federal, state, local and Institutional Review Board policies.

7. If I no longer need confidential information, I will dispose in a way that assures others cannot use or

disclose it including following the Information Technology policy for disposal of printed confidential

information or electronic equipment that may contain confidential information.

8. I understand that my communication using the Columbia University information network is not private

and the content of my communication may be monitored to protect the confidentiality and security of the

data.

9. I understand that my obligation under this Agreement will continue after termination of my relationship

with CUMC.

10. I understand that I have no right or ownership interest in any confidential information referred to in this

Agreement. CUMC may at any time revoke my access code, or access to confidential information. At all

times during my relationship, I will act in the best interests of CUMC.

_______________________________

_________________________

Name (print)

Date

_______________________________

_________________________

Name (sign)

Department

A copy of this Agreement should be kept in the Department

April 2011

Confidentiality Agreement Page 2

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