UNIVERSITY OF MAINE SYSTEM

 

 

CONFIDENTIALITY AGREEMENT

 

 

 

 

The University of Maine System has a legal and ethical responsibility to protect the privacy of all patients and their health information.  In the course of my employment/assignment at                                                                             

                               , I may come into possession of confidential health information, even though I may not be directly involved in providing patient health care.

 

I understand that such information must be kept confidential.  As a condition of my employment/assignment, I hereby agree that I will not, at any time during or after my employment/assignment with                                                                 , disclose any patient information to any person, or use patient information, other than as necessary in the course of my employment/assignment, or as required by law.  I agree to be accountable for the use of security measures and procedures regarding protected health information (PHI) as stated in the University of Maine System HIPAA General Operating Policies.

 

I understand that violation of the confidentiality agreement may result in disciplinary action, up to and including dismissal.

 

 

 

 

                                                                                                                                                      

                                   Signature