Hipaa Confidentiality Agreement printable pdf download

Medical Reserve Corps Volunteer

HIPAA Confidentiality Agreement

The following information explains and governs your use and exposure to confidential health information

as a volunteer for the Medical Reserve Corps through the Washoe County Health District. The U.S.

Department of Health and Human Services (HHS) issues the Privacy Rule to implement the requirement

of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you have any questions

regarding this information you should consult the Medical Reserve Corps Program Coordinator or the

Washoe County Health District’s HIPAA Compliance Officer.

As used herein, the following terms and definitions apply:

1. Confidential Information: includes any information, regardless of the manner in which it is

communicated or maintained (e.g. oral, paper, electronic), received by the Washoe County Health

District, or any of their agents, that falls into one or more of the following categories:

a. Protected Health Information - Information relating to the past, present, or future

physical or mental health or condition of an individual; the provision of health care to an

individual; or the past, present, or future payment for the provision of health care to an

individual. Protected Health information includes demographic information, e.g. address,

telephone number, employer, date of birth, next of kin, identification numbers.

b. Personnel Information – Information relating to a person’s status as a member of the

Washoe County Health District’s workforce, including but not limited to compensation,

employment records, accommodations, performance reviews, and disciplinary actions.

c. Business Operations Information – Information relating to the Washoe County Health

District’s operations, including but not limited to financial and statistical records, strategic

plans, internal reports, memos, contacts, pricing, staffing levels, supplier information,

remote site information, communications, proprietary computer programs, source code and

proprietary technology.

d. Third Party Information – Information belonging to a third party utilized by the Washoe

County Health District for limited purposes pursuant to an agreement with the third party,

including but not limited to computer programs, client and vendor proprietary information,

source code and proprietary technology.

2. Receive, Receiving, or Receipt – means, with respect to Confidential Information, to come into

possession, custody, or control; to perceive; to create; to gain the ability to come into possession,

custody, or control; or to gain the ability to perceive Confidential Information in whatever form

(oral, visual, written, electronic or otherwise).

Hipaa Confidentiality Agreement