CONFIDENTIALITY STATEMENT AND AGREEMENT

for at-home medical transcriptionist

I understand that I may be granted access to certain information maintained by Saint Elizabeth Regional Medical Center (‘the Medical Center”), including but not limited to health records information. Execution of this agreement and continued compliance with all of the promises made and obligations imposed in this Confidentiality Statement and Agreement are conditions of receiving authorization for access to any information maintained by the Medical Center.

As a condition of my employment by the Medical Center, I agree that all information that I obtain during the course of my employment is strictly confidential. I understand that such confidential information includes, but is not limited to, all patient and health records information, quality assurance and utilization review information, strategic planning, computer password (s) issued to me, and any other proprietary information concerning any aspect of the Medical Center’s operation. I agree to maintain the integrity and confidentiality of patient and other confidential information in the home situation.

I also agree that any disclosure of, unauthorized use of and/or unauthorized access to the confidential information may result in my immediate termination from employment. I agree to undertake the following obligations with respect to such confidential information:

  1. To use confidential information for the sole purpose of performing the duties for which I have been hired;
  2. To not copy or reproduce, or permit any other person to copy or reproduce, in whole or in part, any confidential information other than in the regular course of the services I am authorized and requested to perform for the Medical Center;
  3. To not allow others to use, view or otherwise have access to information available to me to perform my job in my home;
  4. To not allow others access to, or use of, hardware and/or software provided to me by the Medical Center;
  5. To assure all physical property of the Medical Center and confidential information is reasonably secured from theft, damage or inappropriate access;
  6. To comply strictly with all Medical Center policies regarding the security of confidential information;
  7. To report immediately to the Medical Center any unauthorized use, access, duplication, disclosure and/or dissemination of confidential information by any person, including myself;
  8. Upon termination of my employment for any reason or at the direction of the Medical Center, I agree to return immediately to the Medical Center in good condition any documents, equipment, software or other media or property of the Medical Center containing any confidential information and/or any other property of the Medical Center, and I will certify in writing that all such documents, equipment, software or other media and/or any other property of the Medical Center that has been provided to me during the course of my employment have been returned to the Medical Center; and
  9. I agree that all my obligations under this Confidentiality Statement and Agreement shall survive and continue following the termination of my employment by the Medical Center regardless of the reason for such termination.

Accepted and Agreed to by:

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Associate (Print) Signature Date

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Witness (Print) Signature Date