EMPLOYEE CONFIDENTIALITY FORM

Confidentiality of Information Statement

All employees of the Detroit Medical Center must accept the terms of, and agree to be bound by, this Confidentiality of Information Agreement (“Agreement”) prior to being assigned duties or a computer access code or password authorization. No alterations to this Agreement are allowed.

As an employee of the DMC, I understand that information to which I must have access in order to perform my duties may include patient information or information regarding the operation of the DMC. I am only permitted to access patient medical information to the extent necessary for me to provide patient care or perform my duties. I also understand that all medical and personal information regarding patients is confidential and unless directly related to the care of patients and authorized by DMC policy, should not be revealed or discussed with other patients, friends or relatives, or anyone else within or outside the Detroit Medical Center healthcare environment.

I also understand that other information regarding the operations of the DMC is confidential. This includes any information regarding employees, financial operations, quality assurance, utilization review, risk management, research, procurement, contracting and credentialing of staff. I understand that I am only authorized to access this information if it is required in order for me to perform my duties. This information should not be revealed or discussed with others within or outside the DMC except to the extent that this discussion is necessary to perform my duties.

I also understand that I may not view my own medical record without the proper authorization. I shall not electronically access my own medical records, or that of my family members, including lab or test results, except as a legitimate function of my job duties or with proper authorization.

I understand that I am required to protect any DMC patient or operations information from loss, misuse, unauthorized access or modification, and to immediately report any suspected breach of security policies.

I understand that I may be given access codes or passwords to DMC computer systems. I will safeguard the security codes and passwords given to me. I acknowledge that I am strictly prohibited from disclosing my security codes to anyone including my family, friends, fellow workers, supervisors, and subordinates for any reason. I agree DMC data and EPHI reside and shall be stored ONLY on DMC servers and NOT on any laptop, PCs nor any other device whether owned by DMC or not.

I understand that I may only use my access security codes to perform my duties. I agree that I will not use anyone else’s security codes to obtain access to any computer systems. I understand that I will be held accountable for all work performed or changes made to the system or databases under my security codes and that I will not allow anyone else to access the computer using my security codes or leave my computer unattended.

I understand that failure to abide by the terms of this Confidentiality of Information Agreement is cause for termination of employment, revocation of privileges, or revocation of access to the DMC, and may be noted in my personnel record.

Completion of this section is required for System/Network Access. Personal Verification Data - Please complete all of the following:
MM/DD/YYYY
(999) 999-9999