Patient, financial, and other business-related information in any form, electronic or printed, is a valuable asset, and is considered private and sensitive. Volunteers may have access to confidential information in the performance of their duties. Those charged with this responsibility must comply with information confidentiality/security policies in effect at UnityPoint Health (UPH) and its affiliates. This agreement applies regardless of the method of access used.

In consideration of being allowed access to UnityPoint Health information systems, I, the undersigned, hereby agree to the following provisions:
1. I agree to abide by all present and future confidentiality/security policies and procedures for UPH and its affiliates. I understand that such policies and procedures have been provided directly to me. Policies and procedures will change from time to time and I understand it is always my responsibility to be aware of policy changes through volunteer communication including but not limited to: Images, volunteer newsletters, assignment specific information etc.
2. I will not operate or attempt to operate computer equipment without specific authorization.
3. I will not demonstrate the operation of computer equipment or applications to anyone without specific authorization.
4. I agree to maintain a unique password, known only to myself, to access the system to read, edit and authenticate data. I understand that my unique password constitutes my electronic signature and that it should be treated as confidential information. I agree not to share my password with any other individual or allow any other individual to use the system once I have accessed it. I understand that I may change my password at any time.
5. I agree only to access the patient, financial, and/or other UPH business-related information needed for the performance of my duties and responsibilities. I understand that accessing my own patient record or the patient records of my family members is only appropriate to do via the Patient Portal or through the Release of Medical Information process. I agree that I will not use my access granted to me for my job role to look at my record or the records of my family members or others, unless it is in accordance with my professional job duties and responsibilities. Note: Internet access and appropriate usage is governed by a separate policy.
6. I will contact my supervisor, the affiliate compliance officer or Information Security Officer (ISO), or the IT department if I have reason to believe the confidentiality and security of my password has been compromised.
7. I will not disclose any portion of the computerized systems to any unauthorized individuals. This includes, but is not limited to, the design, programming techniques, flow charts, source code, screens, and documentation created by employees, outside resources, or third parties.
8. I will not disclose any portion of the patient’s record except to a recipient designated by the patient or to a recipient authorized by UPH who has a “need to know” in order to provide continuing care of the patient.
9. I will use proper disposal procedures for all printed materials containing confidential or sensitive information.
10. I agree to report any activity which is contrary to UPH policies or the terms of this agreement to my supervisor, the affiliate compliance officer, or a security administrator.
11. I agree to comply with all relevant UPH Compliance Policies, including but not limited to the Mobile Device Policy.
12. I understand that I must sign this Agreement as a precondition to issuance of a computer password for access to the UPH network and/or patient information and that failure to comply with the preceding provisions will result in formal disciplinary action, which may include, but will not be limited to, termination of access, termination of volunteering.