AGRMT RE CONFIDENITALITY AND USAGE OF DATA WITH HONORHEALTH.PDF

NH Forni-4
CONFIDENTIALITY STATEMENT and COMPUTER SYSTEMS ACCEPTABLE USAGE
AGREEMENT
I understand and acknowledge that:
It is my legal and ethical responsibility as an authorized user to preserve and protect the privacy,
confidentiality and security of all protected health information, proprietary and other confidential
information relating to HonorHealth, its patients, activities, affiliates, in accordance with law and
HonorHealth policy.
I agree to access, use or disclose confidential information only in the performance of my HonorHealth
duties, when required or permitted by law, and to disclose information only to persons who have the right
to receive that information. When using or disclosing protected health information or confidential
information, I will use or disclose only the minimum information necessary.
I agree to discuss confidential information only in my workplace and for HonorHealth -related purposes. I
will not knowingly discuss any confidential information within the hearing of other persons who do not
have the right to receive the information. I agree to protect the confidentiality of any protected health
information, proprietary or other confidential information which is disclosed to me in the course of my
relationship with HonorHealth.
I hereby agree, as a condition of continued access to HonorHealth's computer systems, to abide by the
policies and procedures described in HonorHealth's policies. I understand that access to HonorHealth's
computer systems is a privilege and monitored, and which may be revoked at any time at the sole
discretion of HonorHealth.
I understand that it is my responsibility to follow safe computing guidelines. To this end, I agree not to
share my Login or User ID and/or password with anyone, or use the Login or User ID of any other user,
and that any access to HonorHealth electronic information made using my Login or User ID and
password is my responsibility. If I believe that someone else has used my Login or User ID and password,
or if I know of any violation of HonorHealth policy, I will immediately report the use to the appropriate
Information Systems Department or the HonorHealth Corporate Compliance Department and request a
new password.
I understand that if I have any designee working on my behalf, they shall abide by the conditions
above, and I will be responsible for any breaches by my designee.
I acknowledge I have read, understand and agree to the items in this statement and agree to be
bound by these requirements.
First Name Ronald MI P
Last Name Klein DOB
Department/Business Maricopa County Department of Public Health
Name
Signature — Date 1010512017
' -- ------
* Required only if user is NOT an employee, volunteer, physician or student of lionorl -lealth facility.
Business Sponsor Bob England MD / Director
Name/Title*
Business Sponsor Maricopa County Department of Public Health
Department
Bu si ness Sponsor Date
Signature / /512-19 10 f 7
This form is to be maintained by the requesting department.
V20140210

C-86-18- ATTACHED TO AND A PART OF
HonorHealth
Confidentiality Statement and Computer
System Acceptable Usage Agreement
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Mancopa County
Date