Sample Employee Oath - Texas

Texas Department of Health
Employee Confidentiality Agreement

Background Information:

The Texas Department of Health (TDH) guiding principles establish the paramount importance of patient and client confidentiality in the mission of this department. Information in reports, records, correspondence, and other documents routinely dealt with by employees of the Texas Department of Health may be privileged, confidential, private, or a combination of two or more. In each instance, the information may receive its designation by statute or judicial decision. Such statutes as the Open Records Act, Medical Practice Act, and the Communicable Disease Act contain provisions, which make certain information that comes to TDH privileged and/or confidential.

As a general rule, in transactions carried out on a day-to-day basis, the Medical Practice Act makes medical records and information taken from medical records privileged and confidential. All communicable disease records (STD, HIV, and TB) are made confidential by the Communicable Disease Act. Birth and death records are confidential for 50 years through the provisions dealing with vital statistics in the Open Records Act and other laws. If information is "confidential," it is generally information that should be kept secret and is given only to another person who is in a position of trust. "Privileged" information protects a person who has either given or received confidential information from being revealed in a legal proceeding. Other information that contains "highly intimate or embarrassing facts about a person such that its disclosure 'would be highly offensive to a [reasonable] person...'" and is not of legitimate concern of the public or might hold a person up to the scorn or ridicule of his or her peers if made public, is made confidential by the common law doctrine of the right to privacy [ORD-262, 1980]. Statutes that govern the operation of the department may contain additional provisions that render information that comes into the hands of certain programs in the TDH privileged, confidential, and/or private.

Note to employee: If you have questions regarding confidentiality, you should contact your immediate supervisor or the Office of General Counsel. The signed Employee Confidentiality Agreement will be filed in your personnel folder.

Agreement:

I agree that:

• A patient record or any information taken from a patient record is privileged and confidential. In most instances, such information may not be released unless the person identified in the record provides written consent, or the release of information is otherwise permitted by law. A patient record is defined as: a record of identity and diagnosis of a patient that is initiated and maintained by, or at the direction of a physician, dentist, or someone under the direction or protocols of a physician or dentist.

• I understand that I must not release information from reports, records, correspondence, and other documents, however acquired, containing medical or other confidential information, and that I may not release such information except in a manner authorized by law, such as in a statistical form that will not reveal the identity of an individual or with the written consent of the individual involved.

• I may not release or make public, except as provided by law, Individual case information including demographic data and client contacts.

• I will keep all confidential files, including computer diskettes, in a locked file cabinet when not in use.

• When I am working on a confidential file, I will "lock up" the information when I leave my workstation for lunch, meetings, or for the day. I understand that to "lock up" the information includes logging off my computer, not merely saving and closing the confidential file.

• I will keep any confidential files I work with out of the view of unauthorized persons.

• I will not discuss confidential information with people who are not authorized, and/or who do not have a need to know the information.

• When I work with files that contain personal identifiers, I will log off my computer when I am not actively using the file.

• I will conduct telephone conversations and/or conferences, that require the identification of patients by name, in secure areas where the conversation or conference will not be overheard or seen.

• To protect confidentiality, I will not discuss the facts contained in confidential documents in a social setting.

• When transporting information that is privileged, confidential, or private, I will employ appropriate security measures to ensure the material remains protected.

• I will keep information relating to the regulatory activities of the department confidential. Regulatory activities include at least the following: survey schedules, unannounced site visits, survey results, information pertaining to complaints that have been investigated, litigation information, and personnel actions.

• Where applicable, departmental policy requires that personnel have individual passwords to access confidential computer files. I will not use another person's password nor will I disclose my own.

• I understand that my superiors will document any violations of this agreement and he or she will place the documentation in my main personnel file maintained by the Bureau of Human Resources.

• If I am a professional employee (e.g. physician, registered nurse, attorneys, etc.) or I am an employee supervised by or providing support to a professional employee, I understand that I may be subject to additional rules of confidentiality. This agreement does not supersede the code of professional conduct and I further understand that a violation of the code of professional conduct may subject the professional employee to additional sanctions (e.g. loss of license.)

• When I dispose of a document that contains patient information, I will assure that the document is shredded.

I have read this Confidentiality Agreement and I understand its meaning. As an employee of the Texas Department of Health, I agree to abide by the Confidentiality Agreement. I further understand that should I improperly release or disclose privileged, confidential, or private information, I may be subject to an adverse personnel action, up to and including the termination of my employment. I understand that I may be subject to civil monetary penalties, criminal penalties or liability for money damages for such an action.

Signature:

Employee's Name:_________________

Print Employee's Name                   Date

Employee's Signature:_______________

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Sample Employee Oath - Seattle/King County

Public Health-Seattle & KingCounty (PH-SKC)
Prevention Division-HIV/AIDS Epidemiology Unit

Confidentiality Agreement

As a PH-SKC employee in the HIV/AIDS Epidemiology Unit, or as a subcontracted employee, student, visiting professional, or work study student, I understand that I may have access to confidential information on persons with reportable diseases, persons counseled during clinical or prevention activities, study participants, or clients of sites involved in our work. This information includes any surveillance- or study-related electronic or paper records or information given orally during an interview or counseling session or through other related contact (e.g., scheduling appointments or updating locators in person or on the phone). Information may also come from records of participating institutions and health care providers, medical/health clinics, drug treatment centers and jails. Examples of confidential information include but are not limited to names, addresses, telephone numbers, sexual and drug-use behaviors, medical, psychological and health-related conditions and treatment, religious beliefs, finances, living arrangements, and social history. By signing this statement, I am indicating my understanding of my responsibilities and agree to the following:

• I agree to uphold the confidentiality and security policies specific to my work site(s) and, if required by my work site protocol, to wear my badge that identifies me as a PH-SKC employee when conducting any research, surveillance or prevention activities at field sites outside the office.

• I agree not to divulge, publish, or otherwise make known to unauthorized persons or to the public any information obtained that could identify persons reported with notifiable diseases, persons served during the course of prevention or clinical activities, participants in research or evaluation studies or any information regarding the identity of any patient or client of any institution including any alcohol or drug treatment program to which I have access.

• I understand that all client, patient, and disease report information and records compiled, obtained, or accessed by me in the course of my work are confidential. I agree not to divulge or otherwise make known to unauthorized persons any information regarding the same, unless specifically authorized to do so by office protocol or by a supervisor acting in response to applicable law, court order, or public health or clinical need (WA Administrative Code 246-101-515).

• I understand that I am not to read information and records concerning patients, clients, or study participants, or any other confidential documents, nor ask questions of clients during interviews for my own personal information but only to the extent and for the purpose of performing my assigned duties.

• I understand that a breach of security or confidentiality may be grounds for disciplinary action by PH-SKC, and may include termination of employment.

• I understand that the civil and criminal penalties set forth in the Revised Code of Washington (RCW 70.24.080 and 70.24.084) include, for each breach of STD/HIV records, a fine of $1000 or actual damages for negligent violation and $10,000 or actual damages for intentional or reckless violation, which I would be personally responsible for paying. Breach of other communicable disease records may result in civil penalties imposed by a court and include actual damages and attorneys' fees (RCW 70.02). Alcohol and drug abuse patient records are protected by federal law (42 CFR Part 2) with criminal penalties for violation.

• I understand that action to impose civil or criminal penalties against me may be taken by a prosecuting attorney or another party with standing if I am suspected of being responsible for a breach of confidentiality.

• I agree to notify my supervisor immediately should I become aware of an actual breach of confidentiality or a situation which could potentially result in a breach, whether this be on my part or on the part of another person.

__________________________________

Signature          Date          Printed name

__________________________________________________

Signature of Program Manager          Date          Printed name

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Sample Employee Oath - Louisiana

State of Louisiana
Department of Health & Hospitals

Louisiana Office of Public Health
HIV/AIDS Program

Confidentiality Agreement

As an HIV/AIDS Program employee, subcontracted employee, student, or visiting professional, I understand that I will be exposed to some very privileged patient information. Examples of such information are medical conditions, medical treatments, finances, living arrangements, and sexual orientation. The patient's right to privacy is not only a policy of the HIV/AIDS Program, but is specifically guaranteed by statute and by various governmental regulations.

I understand that intentional or involuntary violation of the confidentiality policies is subject to appropriate disciplinary action(s), that could include being discharged from my position and/or being subject to other penalties. By initialing the following statements I further agree that:
Initial below

_____ I will never discuss patient information with any person outside of the program who is not directly affiliated with the patient's care.

_____ If in the course of my work I encounter facilities or programs without strict confidentiality protocols, I will encourage the development of appropriate confidentiality policies and procedures.

_____ I will handle confidential data as discretely as possible and I will never leave confidential information in view of others unrelated to the specific activity. I will keep all confidential information in a locked cabinet when not in use. I will encrypt all computer files with personal identifiers when not in use.

_____ I will shred any document to be disposed of that contains personal identifiers. Electronic files will be permanently deleted, in accordance with current HAP required procedures, when no longer needed.

_____ I will maintain my computer protected by power on and screen saver passwords. I will not disclose my computer passwords to unauthorized persons.

_____ I understand that I am responsible for preventing unauthorized access to or use of my keys, passwords, and alarm codes.

_____ I understand that I am bound by these policies, even upon resignation, termination, or completion of my activities.

I agree to abide by the HIV/AIDS Program Confidentiality Policy. I have received, read, understand, and agree to comply with these guidelines.

Warning:Persons who reveal confidential information may be subject to legal action by the person about whom such information pertains. 

_______________________________________________

Signature                                                                 Date

_________________________________________________

Printed Name

________________________________________________

Supervisor's Signature                                                    Date

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