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 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 I agree to the terms of this Confidentiality Agreement. I understand and agree that 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 with UAMS ends. When no longer required for my specific job duties at UAMS, I agree to return to UAMS or destroy all PHI in my possession.

I understand and agree that if I access, use or disclose Confidential Information in any form - verbal, written, or electronic - in a manner that is inconsistent with or in violation of the Confidentiality Policy, UAMS may impose disciplinary action, including but not limited to, immediate termination of employment, dismissal from an academic program, loss of privileges, or termination of relationship with UAMS.

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 workforce member to share PHI 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 Network and Systems or otherwise except to meet needs specific to my job or position at UAMS.