Fiscal Year 2021-2022
Today's Date: 12/1/2021

TEMPLE UNIVERSITY HEALTH SYSTEM (TUHS)
INFORMATION PRIVACY/SECURITY AGREEMENT
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It is the policy of TUHS to protect the private health information of each TUHS patient and to disclose any Protected Health Information only with the patient’s consent or when required bylaw. In order to be granted access to TUHS’s Protected Health Information (PHI) and/or Electronic Protected Health information (ePHI) I understand and agree to be bound by the TUHS Privacy and Security Policies - Policy #220.00-PATIENT PRIVACY AND CONFIDENTIALITY; Policy # 400.00 -COMPUTER USAGE POLICY; TUHS Corporate Compliance Health Information HIPAA Privacy and Security Supplement.
My signature below indicates that I have read and understand my responsibilities under these policies. In consideration of being permitted access to TUHS systems and patient records, I, the undersigned agree to the following provisions:
I will only access the TUHS Information Systems to review patient records when I have the patient’s consent as provided in the TUHS Notice of Privacy Practices.
I will not access any protected health information that is not essential for me to perform my duties.
I will not disclose any protected patient health information to any unauthorized individuals.
I will only disclose protected health information to recipients authorized by the patient; or pursuant to the procedures described in the TUHS Notice of Privacy Practices to receive that information.
I will maintain assigned passwords or access methods that allow access to TUHS, Information Systems and equipment in strictest confidence and not disclose a password or access method to anyone, at any time, for any reason. Nor will I use any other password or access method.
I will contact the TUHS Help Desk (215) 707-7008 immediately and request a new password if my password is accidentally disclosed or compromised.
I will report activity that is contrary to the provisions of this agreement to the TUHS Privacy Officer (215) 707-5605.
I understand that a violation of these rules may result in disciplinary action up to and including termination for employees and termination of access to TUHS information systems for non-employees.
I understand that a violation of these rules may result on a Security Breach as defined by the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Penalties under HITECH include fines up to $1.5M (per occurrence) or criminal prosecution.