E-Heza Documentation

Protected Health Information Confidentiality Agreement

Workforce-Staff and Contractors

I understand that I require information to perform my duties at TIP Global Health by which I am engaged or for which I am performing services. This information may include, but is not limited to, information on patients, employees, other workforce members, donors, research, and financial and business operations. Confidential information may be in any form, e.g., written, electronic, oral, overheard or observed. I also understand that access to all confidential information is granted on a need-to-know basis. A need-to- know is defined as information access that is required in order to perform my work. I will not disclose confidential information to patients, friends, relatives, co-workers or anyone else except as permitted by TIP Global Health policies and applicable law and as required to perform my work as a consultant, contractor or vendor for TIP Global Health. I will protect the confidentiality of all confidential information, including Protected Health Information (PHI), while at TIP Global Health and after I leave TIP Global Health. All confidential information remains the property of TIP Global Health and may not be removed or kept by me when I leave TIP Global Health except as permitted by TIP Global Health policies or specific agreements or arrangements applicable to my work as a consultant, contractor or vendor for TIP Global Health. If I violate this agreement, I may be subject to adverse action up to and including termination of my ability to work at or on behalf of TIP Global Health. In addition, under applicable law, I may be subject to criminal or civil penalties.

I have read and understand the above and agree to be bound by it.

Name:___________________________________________

Company: ________________________________________

Signature:________________________________________

Date: ____________________________________________

TIP Global Health program for which providing services: ________________________________

Last Modified: 1 January 0001