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DocuSign Envelope ID:5F2A6749-5668-4688-B470-4D344E4C961 F <br /> ORANGE COUNTY HEALTH DEPARTMENT <br /> Contracted Interpreters <br /> Conditions of Contract Statement <br /> Confidentiality <br /> As a Contract Interpreter for Orange County Health Department(OCHD), I acknowledge that I may have <br /> access to information that is confidential as mandated by state and feder al law, HIPAA regulation and/or <br /> Orange County policy.. I recognize my legal obligation as a Contractor to maintain the confidentiality of <br /> information about former and current recipients of OCHD services. <br /> I understand that release of information determined to be confidential by law to unauthorized persons may <br /> result in criminal prosecution, fWther understand that the failure to maintain legally required confidentiality <br /> of information constitutes"misconduct" within the meaning of the Orange County Personnel Ordinance and <br /> may lead to disciplinary action, including termination of contract. <br /> If a question arises regarding whether a release of information may be public record vs. confidential client <br /> information, I will seek assistance from an OCHD Clinic Manager. <br /> Title X Information Requirement <br /> OCHD provides services solely on a voluntary basis. A client's acceptance of service is not a prerequisite to <br /> eligibility or receipt of a non-Title X service(Family Planning).. <br /> As an OCHD Contract Interpreter, you may be subj ect to prosecution under F ederal law if'you coerce or <br /> endeavor to coerce any person to undergo an abortion or a sterilization procedure. <br /> As an Interpreter, your responsibility is to convey the message from the provider to the client to the best of <br /> your ability, without prejudice or personal bias If you are present when an OCHD employee attempts to <br /> coerce a person to undergo an abortion or a sterilization procedure, discontinue interpreting, and report this to <br /> the Clinic Manager. <br /> Public Health Activities in Emergency Situations <br /> In order to fulfill the responsibilities of the department in emergency situations or in training, and due to our <br /> limited number of bilingual staff,you may be asked to work at emergency shelters or other locations <br /> designated by the Health Director or emergency operations. You may also be asked to participate in <br /> emergency drills and exercises. Asa Contractor, you do have the right to decline any of these special <br /> requests <br /> I certify that I have read and understand the conditions stated above I have had an opportunity to discuss the <br /> conditions and requirements of my contract with a designated agency representative. <br /> Contractor Name: Perl a sai tz 1� Date: 8/19/2015 <br /> ��` <br /> Contractor Signature: Date: 8/19/2015 <br /> OCHD Representative: O & ( W�Vl Date: 8/20/2015 <br />