Medical Staff Annual Education Attestation

First Name*:

Last Name*:

Email*:

Please check the boxes to acknowledge:

I have received and reviewed the attached Annual Medical Staff Educational Manual.

I will apply the content and principles of safe practices outlined in the Manual in my daily patient care activities as appropriate.

ATTESTATION OF HIPAA PRIVACY AND DATA SECURITY TRAINING

I will read and understand the below policies and procedures concerning HIPAA and data privacy, as well as my reporting obligations.

I agree to comply with the HIPAA Privacy and Security Rule and related Nicklaus Children’s policies and procedures, applicable to my role. I understand and acknowledge the following:

Adherence with the HIPAA Privacy and Security Rule and related policies and procedures will be expected as part of my continued employment or association. This Attestation is not an assurance of continued employment or association.
I understand that I will have access to Protected Health Information (PHI) and Electronic Protected Health Information (ePHI) and must follow the HIPAA Privacy and Security Rule and Nicklaus Children’s policies and procedures to protect and safeguard PHI and ePHI.
I understand that I cannot utilize the Nicklaus Children’s electronic medical record (EMR) to access information for personal use (i.e., my own medical records, records of family members, friends, colleagues, or people whom I know) without a clinical or business need.
I understand that I can only access or disclose PHI or EPHI for a legitimate business or clinical need.
I understand that I can only request or access information needed to perform my job.
I understand that Nicklaus Children’s has adopted a formal Disciplinary Actions Policy for Privacy and Security Violations and that I have been provided with a copy and reviewed such policy.
I understand that there are consequences for the intentional or unintentional access or disclosure of protected health information and acknowledge that I will take every precaution to safeguard such information and respect the confidentiality of every patient. I further understand that corrective action will be taken subject to the Disciplinary Action Policy and Medical Staff Bylaws for the appropriate disciplinary action process.
I understand that text messaging PHI can only be done while using the Nicklaus Children’s approved messaging application (e.g., PH Connect). Text messaging PHI from any other application is strictly prohibited.
I understand that I cannot utilize my personal email address to send patient or business information as it is prohibited at Nicklaus Children’s.
I understand that I have a duty to report any suspected violations should I witness or become aware of and shall report such violations to the Privacy Officer, the Compliance Department or anonymously to the Compliance Hotline 1-888-323-6248.

If I have questions about the training, materials presented or Nicklaus Children’s Privacy policy and procedures, I understand it is my responsibility to seek clarification from the Compliance Privacy Office.

I acknowledge that I have received and reviewed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Data Security training provided by Nicklaus Children’s Health System as part of the Medical Staff Annual Education Curriculum.

I have read and understand the policies and procedures concerning HIPAA and data privacy, as well as my reporting obligations.