Download ACCESS AND CONFIDENTIALITY AGREEMENT FOR

ACCESS AND CONFIDENTIALITY AGREEMENT FOR PHYSICIAN’S OFFICE STAFF
A request has been made by your employer that you be granted access to confidential information maintained by
University of Missouri Health Care (UMHC) including, but not limited to certain information that is maintained
or transmitted in an electronic form. Your access is to be governed by this agreement and it is important that
you read and become familiar with all of the terms of this agreement. By signing this agreement, you are
signifying that you understand and agree to the responsibilities regarding access and protection of confidential
information as detailed below.
Confidential information is valuable and sensitive and is protected by law and by strict UMHC policies. The
intent of these laws and policies is to assure that confidential information will remain confidential, that is, it will
be used only as necessary to assure appropriate patient care or payment for services in your organization. As a
physician’s office staff member, you are required to conduct yourself in strict conformance to applicable laws and
UMHC policies governing confidential information. Your principal obligations in this area are explained below.
You are required to read and to abide by these duties. The violation of any of these duties will subject you to
discipline, which includes but is not limited to, termination of employment and to legal and regulatory liability.
As a staff member in a physician’s office, you understand that you will have access to confidential information,
which may include, but is not limited to, information relating to:
 Patients (records, conversations, admittance information, patient/member financial information, etc).
 UMHC 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 programs, client and vendor proprietary information source
code, proprietary technology, etc.).
You will access and use confidential information only as needed to perform your legitimate
professional duties as a physician’s office staff member. UMHC also requires that:
A. 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 for the physician’s
office.
B. You will not misuse confidential information or treat confidential information carelessly.
C. You will report activities by any individual or entity that you suspect may compromise the confidentiality of
confidential information to your supervisor. Reports made in good faith about suspect activities will be held
in confidence to the extent permitted by law, including the name of the individual reporting the activities.
You may not be retaliated against for reporting such violations in good faith.
D. You understand that your obligations under this Agreement will continue after termination of your
employment. You understand that your privileges hereunder are subject to periodic review and revision,
and must be renewed annually by the physician practice.
E. You understand that you have no ownership interest in any confidential information referred to in this
Agreement. UMHC may at any time revoke your access code, other authorization, or access to confidential
information.
F. You will be responsible for your misuse or wrongful disclosure of confidential information and for your
failure to safeguard your access code or other authorization to access confidential information. You
understand that your failure to comply with this Agreement may result in termination of employment, and
to legal and regulatory liability for both you and your employer.
Physician Office Staff Member Signature
Agreed to on this date
Printed or Typed Name
Title
Sponsoring Physician’s Signature
Date
Printed or Typed Name
Title