Confidentiality Agreement

Confidentiality Agreement

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Requestor Information
UAMS Contact/Supervisor Information
Confidentiality Agreement

As a condition of my employment, continued employment or relationship, or affiliation with UAMS, I agree to abide by the requirements of the UAMS Confidentiality Policy and with federal and state laws governing confidentiality of a patient's Protected Health Information and other Confidential Information, and I agree to the terms of this Confidentiality Agreement.

I agree to the following terms and conditions:

  • The sign-on and password codes assigned to me are equivalent to my signature, and I will not share the passwords with anyone.
  • I will not attempt to use or share the passwords of another or ask another individual to share PHI or other Confidential Information inappropriately.
  • I will be responsible for any use or misuse of my network or application system sign-on codes.
  • I will not attempt to access information on the UAMS computer and information systems or otherwise except to meet needs specific to my job, position, or other affiliation with UAMS.
  • Unless otherwise specified in a separate written agreement with UAMS, I understand that UAMS owns, and I hereby assign to UAMS, all proprietary information, inventions, data, materials, works of authorship, and tangible research property that I produce within the scope of my employment, relationship, or other affiliation with UAMS.
  • I will not provide any Confidential Information to any third party unless there is a contract as may be required between UAMS and the third party that has been (1) approved by the UAMS Office of General Counsel and (2) signed by an authorized UAMS signatory. Confidential Information includes, but is not limited to, PHI, research collaborator and sponsor information, and UAMS proprietary information, inventions, data, materials, works of authorship, or tangible research property.
  • UAMS reserves and intends to exercise the right to review, audit, intercept, access, and act upon inappropriate use of UAMS's computer systems at any time, with or without user notice.
  • A violation of this user agreement may result in any or all of the following: (i) permanent revocation of my access to UAMS computer and information systems; (ii) disciplinary action related to my employment or other affiliation with UAMS, including termination or dismissal from the academic program; (iii) legal action; (iv) a report to federal and/or state authorities charged with professional licensing, enforcement of privacy rules and regulations, and/or criminal prosecution; (v) civil or criminal penalties imposed against me and/or my employer.
  • The confidentiality laws require me to maintain the confidentiality of this information even when I am not at work or acting within the scope of my relationship with UAMS and also after my employment or relationship or affiliation with UAMS ends. When no longer required for my specific duties and/or activities at UAMS, I agree to return to UAMS or destroy all PHI in my possession.
  • I will adhere to all of the limitations, prohibitions and requirements applicable to covered health care providers under HIPAA as described in 45 CFR 160-164, and use all reasonable and necessary safeguards as required by HIPAA to ensure confidentiality.
  • I assume full responsibility for any resulting harm caused by misuse of or failure to maintain confidentiality, and agree to immediately report any unauthorized use or disclosure of any portion of UAMS's medical record or UAMS information to UAMS immediately.
  • I will not print, screen shot, or copy data from the electronic medical record for use on any other device or at any non-UAMS location.
  • I will take appropriate precautions to ensure that patients, visitors, or unauthorized personnel will not be able to see the computer screen while I am accessing UAMS computer and information systems, and to logout or secure the screen when the application is not being used.
  • Access is provided on an "as-is, as-available" basis and UAMS does not guarantee that I will be able to access UAMS computer and information systems at any particular time in the case of system failures, back-up procedures, maintenance, or other causes beyond the control of UAMS.