Confidentiality Agreement
Applies to all Triumph Consulting “workforce members”
including: employees, staff and other professionals; volunteers;
agency, temporary and registry personnel; and house staff, students,
and interns (regardless of whether they are Triumph Consulting trainees
or rotating through facilities from another institution).
It is the responsibility of all Triumph Consulting workforce members,
as defined above, including employees, clients, staff, house staff,
students and volunteers, to preserve and protect confidential client,
employee and business information.
Confidential Employee and Business Information includes, but is not
limited to, the following:
• Employee home telephone number
and address;
• Spouse or other relative names;
• Social Security number or income
tax withholding records;
• Information related to
evaluation of performance;
• Other such information obtained
from Triumph Consulting’s records which if disclosed, would constitute
an unwarranted invasion of privacy; or
• Disclosure of Confidential
business information that would cause harm to Triumph Consulting.
I understand and acknowledge that:
1. I shall respect and maintain
the confidentiality of all discussions, deliberations, client records
and any other information generated in connection with individual
client, risk management and/or peer review activities.
1. It is my legal and ethical
responsibility to protect the privacy, confidentiality and security of
all records, proprietary information and other confidential information
relating to Triumph Consulting and its affiliates, including business,
employment and medical information relating to our clients, members,
and employees.
1. I shall only access or
disseminate client information in the performance of my assigned duties
and where required by or permitted by law, and in a manner which is
consistent with officially adopted policies of Triumph Consulting, or
where no officially adopted policy exists, only with the express
approval of my supervisor or designee. I shall make no voluntary
disclosure of any discussion, deliberations, client records or any
other peer review or risk management information, except to persons
authorized to receive it in the conduct of Triumph Consulting affairs.
1. My user ID is recorded when I
access electronic records and that I am the only one authorized to use
my user ID. Use of my user ID is my responsibility whether by me or
anyone else. I will only access the minimum necessary information
to satisfy my job role or the need of the request.
1. I agree to discuss confidential
information only in the work place and only for job related purposes
and to not discuss such information outside of the work place or within
hearing of other people who do not have a need to know about the
information.
1. My obligation to safeguard
client confidentiality continues after my termination of employment
with the Triumph Consulting.
I hereby acknowledge that I have read and understand the foregoing
information and that my signature below signifies my agreement to
comply with the above terms. In the event of a breach or threatened
breach of the Confidentiality Agreement, I acknowledge that Triumph
Consulting and its affiliates may, as applicable and as it deems
appropriate, pursue disciplinary action up to and including my
termination from the Company.
Print Name:
Signature:
Department:
Dated:
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