HIPAA Confidentiality Agreement

INDEPENDENT PHYSICIAN, HEALTH CARE PROFESSIONAL AND VENDOR ACCESS AND CONFIDENTIALITY AGREEMENT

HP113-B

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 this agreement is to confirm your understanding of and obtain your commitment to your duties regarding confidential information.

Confidential information is valuable, sensitive, and protected by law and the facility policies. As a Health Care Professional, you are required to conduct yourself in a strict conformance to applicable laws and the facility policies and to abide by the duties described below governing confidential information.

You will be responsible for any alteration, destruction, misuse or wrongful disclosure of confidential medical information by you and for any failure by you to safeguard any authorization codes to access confidential information. You understand that your failure to comply with the duties described below and this agreement may also result in loss of privileges to access confidential information, loss of privileges to treat patients and residents at facilities and to legal liability.

As a Health Care Professional, you understand that you will have access to such confidential medical information that may include, but is not limited to, information relating to:

∙ Patients and residents (such as medical records, private conversations, admittance information, resident financial information, etc.)

  • Other employees (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 proprietary information, 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 at facilities.
    1. You will only access confidential information needed to treat your patients and residents or fulfill your responsibilities.
    2. You will not in any way divulge, copy, release, sell, loan, review, alter, or destroy any confidential information except as properly authorized within the scope of your professional activities as a Health Care Professional and treater of residents affiliated with facilities.
    3. 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 you to access confidential information. You accept responsibility for all activities undertaken using your authorization codes or keys.
  3. You will report to the Facility Privacy Officer activities by any individual or entity you suspect may compromise the confidentiality of confidential information described in this agreement.
  4. You understand that your obligations under this agreement will continue after termination of your privileges or permission to treat patients and residents of facilities. You understand that facilities may review, revise or terminate your privileges to access and use confidential information as reasonably warranted to protect confidentiality of such information.
  5. You understand that you have no right to ownership interest in any confidential information referred to in this agreement. The facility may at any time revoke your key, access code, other authorization, 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 or nature whatsoever. This indemnification includes without limitation, attorneys’ fees, expert witness fees, and costs of investigation, litigation or dispute resolution, relating to or arising out of any breach or alleged breach of this agreement by Health Care Professional.
  7. You will respect 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.