Orange County NC Website
DocuSign Envelope ID: 3A41C8C3- 4643- 4E42- 9E22- 7ED4F266BDF8 <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 federal 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. I further 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 subject to prosecution under Federal 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. As a 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: Kel l e Owens Date: <br />DocuSigned by: <br />Contractor Signature: " 0 -W",,5 <br />DocuSigned by: <br />OCHD Representative: ';'' Pt�VICA (YaWkr ° <br />2F52C29B147F405... <br />Date: 7/12/2018 <br />Date: 7/16/2018 <br />