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Annual policy acknowledgments

Once a year, everyone confirms they’ve reviewed the policies that matter most. Open each one from Policies & procedures if you need a refresher. Questions? Ask your supervisor before you sign.

Confidentiality agreement

In my work at Demo Behavioral Health I will see information about clients, including information about substance use treatment, which federal law protects even more strictly than other health information.

  • I will use and share client information only as my job requires, and only the minimum needed (HIPAA).
  • I will not confirm or deny that anyone is a client, or share anything that could identify someone as a client of a substance use program, without the client’s written consent or another exception allowed by 42 CFR Part 2.
  • I will keep client information in the EHR and other approved systems, lock my screen, and never take client records home or store them on personal devices or accounts.
  • I will not look up clients outside my job, including on social media, search engines, court or Department of Correction sites, or public databases (SOP 10.002-A).
  • I will report any privacy breach, or anything I think might be one, right away.
  • These duties continue after I leave Demo. I understand that breaking them can lead to discipline up to termination, and to civil or criminal penalties.

I have reviewed and agree to follow:

Any outside work, relationships, or financial interests that could conflict with your role at Demo. Write “None” if there aren’t any. Anything you list here is added to the conflict of interest register for leadership to review. Something new comes up during the year? Disclose it any time.

Typing your name here counts as your signature.