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This document outlines the responsibilities of employees and affiliates of the UT Health Science Center regarding the confidentiality and security of patient health information.
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How to fill out Confidentiality/Security Acknowledgement

01
Read the Confidentiality/Security Acknowledgement document carefully.
02
Fill in your name and any required personal information at the top of the form.
03
Review the confidentiality terms outlined in the document.
04
If necessary, consult with a legal advisor to ensure understanding of the terms.
05
Sign and date the document at the designated spot.
06
Submit the completed form to the appropriate department or individual.

Who needs Confidentiality/Security Acknowledgement?

01
Employees handling sensitive information.
02
Contractors working with confidential data.
03
Interns exposed to proprietary information.
04
Collaborators on projects requiring data protection.
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Example: Confidentiality Clause None of the parties shall disclose to any person or use for any purpose any confidential information of the other as a result of entering into this Agreement. This restriction shall continue to apply after the expiration or termination of this agreement without limit of time.
A confidentiality agreement should include a clear definition of the confidential information, scope of the agreement, obligations of the receiving party, the duration of the contract, any exceptions to confidentiality, and the consequences of a breach of the contract.
All confidential information provided by a party hereto shall be used by any other party hereto solely for the purpose of rendering or obtaining services pursuant to this Agreement and, except as may be required in carrying out this Agreement, shall not be disclosed to any third party without the prior consent of such
CONFIDENTIALITY ACKNOWLEDGMENT I will not talk about Project _ to anyone (including other employees, my spouse or significant other) unless I am certain such person is a member of the Project _ team. transaction, the terms of the transaction, party names and timing, must be held in strict confidence.
I agree that: a) I shall not share this information, material or documents (information) with persons within or outside of the __ who are not authorized to have this information. b) I shall not publish such information. c) I shall not communicate such information without authority.
shall hold in confidence all Confidential Information. shall protect all Confidential Information against disclosure. shall safeguard all Confidential Information. shall keep secret all Confidential Information.
What to Say to Address Confidential Information with Candor and Care 1) “I protect sensitive information. 2) “I understand this can feel frustrating (or that you're curious)…” 3) “I'm sorry, but I'm not able to talk about that.”
An Example of Industry-Wide Elegant Variation: Ways of Saying Keep Confidential Information to Yourself shall keep in confidence all Confidential Information. shall treat in confidence all Confidential Information. shall treat as confidential all Confidential Information.

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Confidentiality/Security Acknowledgement is a formal document that outlines an individual's understanding and commitment to protecting sensitive and confidential information related to an organization or its clients.
Typically, employees, contractors, and volunteers who have access to sensitive information are required to file Confidentiality/Security Acknowledgement.
To fill out a Confidentiality/Security Acknowledgement, individuals should provide their personal details, read the terms thoroughly, and sign to indicate their agreement and commitment to maintaining confidentiality.
The purpose of Confidentiality/Security Acknowledgement is to ensure that individuals are aware of their responsibilities regarding the protection of sensitive information and to legally bind them to adhere to those responsibilities.
The information typically required includes the individual's name, position, a statement of understanding regarding confidentiality, the scope of confidential information, and the individual's signature.
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