HIPAA Compliance Training Acknowledgement

By entering your personal information and checking the box below you electronically acknowledge that you have read the source material included in this test and agree with the policies and procedures set forth by promise senior solutions, lLC. you further agree that you will abide by these policies and procedures to the best of you ability.

Employee Name

First Name

Last Name

Last Four of Social Security Number

By Checking "Yes" I shall respect and maintain the confidentiality of all discussions, deliberations, client care records and any other information generated in connection with individual client care, risk management and/or peer review activities.

Yes

By Checking "Yes" It Is My Legal And Ethical Responsibility To Protect The Privacy, Confidentiality And Security Of All Medical Records, Proprietary Information And Other Confidential Information Relating To Promise Senior Solutions And Its Affiliates, Including Business, Employment And Medical Information Relating To Our Clients, Members, Employees And Health Care Providers.

Yes

By Checking "Yes" I Shall Only Access Or Disseminate Client Care 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 Promise Senior Solutions, 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 Care Records Or Any Other Client Care, Peer Review Or Risk Management Information, Except To Persons Authorized To Receive It In The Conduct Of Promise Senior Solutions Affairs.

Yes

By Checking "Yes" I Affirm That My User ID Is Recorded When I Access Electronic Records And That I Am The Only One Authorized To Use My User ID. I Will Only Access The Minimum Necessary Information To Satisfy My Job Role Or The Need Of The Request. *

Yes

By Checking "Yes" 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.

Yes

By Checking "Yes" I Understand That Any And All References To HIV Testing, Such As Any Clinical Test Or Laboratory Test Used To Identify HIV, A Component Of HIV, Or Antibodies Or Antigens To HIV, Are Specifically Protected Under Law And Unauthorized Release Of Confidential Information May Make Me Subject To Legal And/Or Disciplinary Action.

Yes

By Checking "Yes" My Obligation To Safeguard Client Confidentiality Continues After My Termination Of Employment With The Promise Senior Solutions.

Yes