Student Health Service Confidentiality And Security Agreement printable pdf download

STUDENT HEALTH SERVICE

CONFIDENTIALITY AND SECURITY AGREEMENT

Purpose: The Health Insurance Portability and Accountability Act (HIPAA) and its regulations, the California Confidentiality of Medical Information

Act and other federal and state laws and regulations were established to protect the confidentiality of medical and personal information, and provide,

generally, that patient information may not be disclosed except as permitted or required by law or unless authorized by the patient. These medical

privacy laws and regulations apply to all members of the University of California, Santa Barbara, Health System (UCSB HS) workforce including

faculty, staff, residents, fellows, medical and other students and volunteers. All members of the workforce of the Health System are required to agree

to and sign this confidentiality statement.

CONFIDENTIALITY STATEMENT

As a member of the UCSB HS workforce, I understand that I may be working with confidential medical and other sensitive or private information.

This information may include, but is not limited to, medical records, personnel information, ledgers, verbal discussions, and electronic

communications including e-mail.

I understand and acknowledge that HIPAA requires that I be trained on the requirements of HIPAA and UCSB SH policies, procedures and

guidelines relating to protection of confidential patient information, and I agree to obtain all required training before I access, use or disclose any

confidential patient information.

I acknowledge that it is my responsibility to respect the privacy and confidentiality of patient and other confidential information. I will not access, use

or disclose patient or other confidential information unless I do so in the course and scope of fulfilling my duties as a member of the UCSB HS

workforce. I understand that I am required to immediately report any information about unauthorized access, use or disclosure of confidential patient

information. Initial reports go to the UCSB HIPAA Compliance Officer. If electronic media is involved, an incident report will be forwarded to the

Campus Sensitive Data Incident Coordinator.

I understand and acknowledge that, should I breach any provision of this agreement, I may be subject to civil or criminal liability and/or disciplinary

action consistent with applicable University policies, bargaining contracts and University processes.

For more information on UCSB HS HIPAA-related policies, procedures and guidelines please contact your departmental HIPAA representative.

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INFORMATION SECURITY POLICY

Purpose: The purpose of this policy is to establish requirements which all employees of Student Health (SH) and any other persons with access to

SH information systems must follow in order both to prevent the improper disclosure of confidential information and to prevent unauthorized persons

from gaining access to confidential information. SH maintains data on the Student Affairs (SA) Network which is supported by Student Information

Systems and Technology (SIS&T). The University has a duty to safeguard confidential information which is accessible via this network and to insure

that the use of computer workstations is in compliance with federal and state regulations and with University and campus policies.

Privileged Information: Except as provided for by law or policy, any information that contains personally identifiable elements is confidential.

All charts, reports, records, and conversations regarding care of patients of SH are kept confidential and are not discussed outside of the

department.

You are only allowed to access and view confidential information that is necessary for you to do your job. You may not access medical records

for any other purpose.

You may not discuss confidential information in public places. You may not leave documents displaying visible confidential information in open

places. You may not disclose confidential information to any one in any form or by any means without the written consent of the identified

person(s) except as provided for by law or policy, or to inform other employees who have a need to know.

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Network Password Protocol: Your password is the key that provides access to confidential information. Passwords must be kept secret to assure

confidentiality.

You must maintain your password as a secret code which you may not communicate to anyone, except as provided by item 7 below. If you

reveal your password you are personally responsible for any adverse actions which may occur as a result.

You may not write down your password.

No employee, including your manager, has the right to request that you reveal your password. Do not reveal it to anyone.

You must change your password when it expires.

Your password must be at least 8 characters long and must include at least one uppercase letter, one lowercase letter and one number.

You may not use your SH password in any other system not supported by SH.

Where special circumstances require a shared workstation, the workstation manager is responsible for assigning the password and may only

reveal it to individuals who have signed confidentiality agreements.

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J:\HIPAA/Documents/Confidentiality Agreements/2008 Confidentiality and Security

Student Health Service Confidentiality And Security Agreement

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