Patient Data Confidentiality printable pdf download

Patient Data Confidentiality

and Remote Access Agreement

This Patient Data Confidentiality and Remote Access Agreement applies to workforce members who

are authorized to access electronic information systems, including but not limited to:

____________________________________________________________________________

I understand that as a result of my own or my employer’s relationship (contractual or otherwise) with

the Alabama Department of Public Health involving access to or exchange of patient information, I

have a legal and/or ethical responsibility to safeguard the confidentiality and integrity of electronic

medical records, protected health information (PHI) and/or other proprietary data, including financial

information, to which I come in contact. I will access, use or disclose this confidential information

ONLY when it is necessary, appropriate and lawful to do so in the performance of my duties and in

accordance with the Department’s use and disclosure policies.

I understand that if I fail to adhere to the provisions of this confidentiality agreement or the

Department’s use and disclosure policies, I may be subject to remedial action, such as termination of

my employment or contract, formal warning, suspension and/or permanent revocation of

authorization to access electronic information systems.

Additional Terms and Conditions

1. I will access the Department’s electronic

containing electronic media (including smart

information systems and the data within ONLY

phones, tablets and other handhelds) when not

if I am authorized to do so AND I have a work-

in use, using password-protected screen

related reason based on my job or position. I

savers, and positioning

will not access these systems or the data

computer or mobile device screens that show

within for personal reasons of any kind.

confidential information away from the view of

unauthorized persons.

2. I will access PHI ONLY after having received

prior authorization, or when appropriate and

5. I understand that the Department reserves

lawful based on the Department’s use and

the right to log, access, review, monitor, audit

disclosure policies, the Health Insurance

or otherwise utilize information stored on or

Portability and Accountability Act of 1996

passing through its electronic information

systems in order to manage and enforce

(HIPAA), and/or other state and federal laws.

patient data privacy and security policies.

3. I will not in any way divulge, copy, release,

alter or destroy any confidential information,

6. When accessing electronic information

including PHI, except as authorized by the

systems, I will use ONLY those credentials

Department or as required by law.

assigned to me, which may include a User ID

and password. I will NOT:

4. I will avoid inappropriate disclosure of

a. share, disclose or publicly display my

confidential information, including PHI, by

credentials; or

using appropriate security measures. These

b. use tools or techniques to break, exploit or

measures may include, but are not limited to:

otherwise circumvent established security

locking up laptops, electronic media (such as

measures.

CDs and USB flash drives) and mobile devices

September 2014

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Patient Data Confidentiality

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