University of Michigan-Flint School of Health Professions and Studies
Confidentiality and Security Statement
(Workforce, Vendor, Visiting Observer and Scholar)
The University of Michigan-Flint School of Health Professions and Studies (UM-Flint SHPS) is committed to protecting the confidentiality and security of information. I may be an employee, faculty, student, trainee, visiting observer or scholar, volunteer, or vendor at UM-Flint SHPS. During the course of my duties or purpose at the SHPS I may have access to proprietary or confidential information. I understand that all proprietary and protected health information (collectively PHI) must be maintained confidentially, and in a secure fashion.
I agree to follow all UM-Flint SHPS policies and procedures governing the confidentiality and security of PHI in any form, including oral, fax, photographic, written, or electronic. I will regard both confidentiality and security as a duty and responsibility while part of the SHPS workforce, or during my involvement with UM-Flint SHPS as a non-workforce member. I have completed HIPAA training.
I agree that I will not access, release, or share PHI, except as necessary to complete my duties or purpose at the UM-Flint SHPS. I understand that I may not access any information on friends or family members unless a Release of Information form authorizes me to do so, unless doing so is a necessary part of my job duties, or unless I am otherwise permitted to do so by UM-Flint SHPS policies. I understand that I am not authorized to use or release PHI to anyone who is not part of the UM-Flint SHPS workforce or an approved visiting observer or scholar except as provided in UM-Flint SHPS policies and procedures, by University of Michigan contract, or as required by law.
I agree that I will use all reasonable means to protect the security of PHI in my control, and to prevent it from being accessed or released, except as permitted by law. I will use only the access privileges I have been authorized to use, and will not reveal any of my passwords or share access with others. I will take precautions to avoid inadvertently revealing PHI; for example, I will use workstations in a safe manner and will make reasonable efforts to prevent conversations from being overheard, including speaking in lowered tones and not discussing PHI in public areas. If I keep patient notes on a handheld or laptop computer or other electronic device, I will ensure that my supervisor knows of and has approved such use and I will keep this information secure and confidential. If, as part of my responsibility, I must take PHI off the premises, I will do so only with permission from my supervisor; I will protect PHI from disclosure; and will ensure that the PHI is either returned to UM-Flint SHPS or destroyed.
I agree that when my employment, affiliation, visitation or assignment with UM-Flint SHPS ends, I will not take any PHI with me and I will not reveal any PHI that I had access to as a result of my duties at the UM-Flint SHPS. I will either return PHI to UM-Flint SHPS or destroy it in a manner that renders it unreadable and unusable by anyone else.
I agree to report unauthorized use or disclosure of PHI, or security issues affecting systems that contain or give access to PHI, to the Administrative Director of the Urban Health and Wellness Center (810-424-5269), SHPS Dean (810-237-6503), or to the University of Michigan Campus Privacy Office (0248 Fletcher St., Ann Arbor, MI 48109-1050; Confidential Help Line: (734) 936-6885).
I understand that if I do not keep PHI confidential, or if I allow or participate in inappropriate disclosure or access to PHI, I will be subject to immediate disciplinary or corrective action, up to and including dismissal or loss of access privileges to UM-Flint SHPS property and facilities. I understand that unauthorized access, use, or disclosure of PHI may also violate federal and state law, and may result in criminal and civil penalties.
To agree, please fill in the following form fields and click "I agree to the above conditions."