I acknowledge that this statement applies to all members of the University of Florida (UF) workforce who are employed by, contracted to, or under the direct control of the healthcare components of UF, including but not limited to, employees, volunteers, students, physicians, resident physicians, and third parties, whether temporary or permanent, paid or not paid, visiting, or designated as associates.

I understand that the UF healthcare components include the Health Science Centers located in both Gainesville and Jacksonville, and all their direct support organizations and affiliated entities (affiliates) as defined in the UF Privacy Policies and Procedures.

I acknowledge that UF has formally stated in the UF Privacy Policies and Procedures its commitment to preserving the confidentiality and security of health information, whether maintained or distributed in paper, electronic, video, verbal, or any other medium or format. I understand that I am required, if I have access to such health information, to maintain its confidentiality and security.

I understand that access to health information created, received, or maintained by UF or its affiliates in any location is limited to those who have a valid business or healthcare need for the information or otherwise have a right to know the information. I understand that there are many administrative, physical and technical safeguards in place to protect the privacy and security of this health information, and that any attempt to bypass or override these safeguards is a violation of federal and state laws and the privacy and security policies of the University of Florida.

I understand that anyone who is authorized to access electronic health information within UF and affiliated systems will be issued a unique user identification and password, and that any person who knowingly discloses their user ID or password to others, uses or discloses another individualís user ID or password, or accesses any electronic protected health information without authorization is subject to disciplinary action, up to and including dismissal. In addition, I understand that all UF and affiliate workforce members must comply with applicable Information Technology Security Policies.

I understand that approved methods and purposes for access to, uses and disclosures of, and requests for, any and all protected health information, created, received or maintained by UF and its affiliates, are limited to those described in the UF Privacy Policies and Procedures. I further understand that, with the exception of purposes related to treatment, access to, uses and disclosures of, and requests for an individualís health information must, to the extent practicable, be limited to the minimum necessary to accomplish the intended purpose of the approved use, disclosure or request.

I understand that any known or suspected violation of the privacy or security of health information must be reported to my immediate supervisor or to the Privacy Office immediately.

I have read the UF Confidentiality Statement and I understand that violating the UF Privacy Policies may result in disciplinary action, up to, and including, dismissal, by UF or its affiliates in accordance with UF policies and University Regulations 1.008, 3.046, 3.047, 4.041, and 7.048, as applicable.

I have read the University of Florida Health Information Policy.

By entering my name and other identifying information on this page, I am registering my agreement with the above statements.

NOTE: You may register even if you do not have a UFID. See the instructions on the following screen.

Confidentiality Statements are "signed" online annually. They may also, but are not required to, be printed, signed by hand, and placed in the personnel, student, or other appropriate file of the signer. The Privacy Office does not require actual signatures on Confidentiality Statements as long as the signer's information is registered in the Privacy Office database.

The most recent statement that was registered on-line may be retrieved using the “Certificate Lookup” link on the Health Information Privacy homepage.

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