Woods and Water Medical Center

CONFIDENTIALITY AND SECURITY

AGREEMENT
I understand that Woods and Water Medical Center in which or for whom I work, volunteer,
receive student training, or provide services, or with whom the entity (e.g. physician practice)
for which I work has a relationship (contractual or otherwise) involving the exchange of health
information (Woods and Water Medical Center), has a legal and ethical responsibility to safeguard
the privacy of all patients and to protect the confidentiality of their patients health
information. Additionally, Woods and Water Medical Center must assure the confidentiality of
its human resources, payroll, fiscal, research, internal reporting, strategic planning,
communications, computer systems and management information (collectively, with patient
identifiable health information, Confidential information).
In the course of my employment/assignment/student training at Woods and Water Medical
Center, I understand that I may come into the possession of this type of Confidential
Information. I will access and use this information only when it is necessary to perform my job-
related duties in accordance with Woods and Water Medical Centers Privacy and Security
Policies available on Woods and Water Medical Centers information systems. I further
understand that I must read, sign, and comply with this Agreement in order to obtain
authorization for access to Confidential Information.

1. I will not disclose or discuss any Confidential

Information with others, including friends
or family, who do not have a need to know
it.
2. I will not discuss Confidential Information
where others can overhear the
conversation. It is not acceptable to discuss
Confidential Information even if the
patients name is not used.
3. I understand that I must safeguard and
maintain the confidentiality, integrity, and
availability of all Confidential Information I
use, disclose, and/or access at all times,
whether or not I am at work and regardless
of how it was accessed.
4. I will only access, use, and/or disclose the
minimum necessary Confidential
Information needed to perform my
assigned duties and disclose it to other
individuals/organizations who need it to
perform their assigned duties or as allowed
by law.
5. I will not access my own or my familys
medical records in any information system
without prior Authorization from the HIM
Manager (unless required to perform you
job duties.
6. I will not make any unauthorized
transmissions, inquiries, modifications, or
purging of Confidential Information.
Furthermore, I will not download and
Confidential Information off Woods and
Water Medical Centers system or disc, zip
discs, flash drives, other portable media,
etc. except in situations where explicit
approval to do so has been granted by the
IT department with prior review by the
Security & Privacy Officer. If I received this
approval to download data I will assume
sole and absolute responsibility to manage
and protect it based upon standards listed
in the Agreement and according to the law.
7. I will not in any way divulge copy, release, entities, in accordance with approved
sell, loan, alter, or destroy and Confidential security standards.
Information except as properly authorized.

8. I agree that my obligations under this

Agreement will continue after my
termination of my employment, expiration
of my contract, or my relationship ceases
with Woods and Water Medical Center.
16.
9. Upon termination, I will immediately return
any documents or media containing
Confidential Information to Woods and
Water Medical Center.
17.
10. I understand that I have no right to any
ownership interest in any information
accessed or created by me during my
relationship with Woods and Water Medical
Center.
I will:
a. Use only my officially assigned User-ID and
password.
b. Use only approved licensed software.
I will never:
a. Share/disclose User-Ids and passwords.
b. Use tools or techniques to break/exploit
security measures.
c. Connect to unauthorized networks through
the systems or devices.

11. I will act in the best interest of Woods and
Water Medical Center and in accordance
with its Code of Ethics at all times during my
relationship with Woods and Water Medical
Center.
12. I understand that violation of the
Agreement may result in disciplinary action,
up to and including termination of
employment, suspension and loss of
privileges, and/or termination of
authorization to work within Woods and
Water Medical Center, in accordance with
Woods and Water Medical Centers policies.
13. I will only access or use systems or devices
that I am officially authorized to access, and
will not demonstrate the operation or
function of systems or devices to
unauthorized individuals.
18. I will notify my manager or IT if my password has
been seen, disclosed, or otherwise
compromised, and will report activity that
violates this Agreement, privacy and security
policies, or any other incident that could have
any adverse impact on Confidential Information.
19. I have received training on how to protect health
information/confidentiality as necessary and
appropriate to perform my job responsibilities.
20. I understand that I will be held accountable for
all inquiries, entries, and changes made to any of
Woods and Water Medical Centers information
systems using my User name(s) and password(s).

14. I will practice good workstation security

measures such as locking up diskette when
not in use, using screen savers with
activated passwords appropriately, and
position screens away from public view.

15. I will practice secure electronic

communications by transmitting
Confidential Information only to authorized
 Refer any questions related to this Agreement to the Security Officer or Privacy Officer.

By signing this Agreement, I agree to comply with its terms and conditions. Failure to read this Agreement is not an excuse
for violating it. The IT department may deny access to Woods and Water Medical Centers information systems if
this Agreement is not returned signed and dated.

Employee Signature Date

Employee Printed Name

Return this completed from to Human Resources

11/09/2011