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2017-745-E Health - Family Success Alliance Master Data Sharing Agreement United Way
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2017-745-E Health - Family Success Alliance Master Data Sharing Agreement United Way
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Last modified
2/11/2019 1:54:58 PM
Creation date
12/20/2018 2:46:28 PM
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DocuSign Envelope ID: D6EB45D6-6C12-4C2B-895B-067AF17D828F <br /> Master Data-Sharing Agreement <br /> Attachment B:Staff Confidentiality Pledge Assurance of Confidentiality <br /> UWGT and Orange County FSA assures all individual participants that the information they release to the <br /> UWGT and Orange County FSA will be held in the strictest confidence and that such information will only <br /> be disclosed to authorized persons in a specified manner.Access to Orange County FSA data is by <br /> consent of the participants who have been guaranteed confidentiality and assured that their personally <br /> identifiable information will only be used in a manner consistent with the terms of their consent. <br /> I have carefully read and understand this assurance that pertains to the confidential nature of all <br /> information and records to be handled by Orange County FSA. I have read a copy of the Master Data- <br /> Sharing Agreement, and I understand that I must comply with all of the requirements of that plan.As an <br /> employee of , I understand that I am prohibited from <br /> disclosing any such confidential information which has been obtained from Orange County FSA or UWGT <br /> to anyone other than authorized staff, and I agree to follow the data security procedures outlined to me <br /> during training. I understand that any willful and knowing disclosure of information released to this <br /> study may subject me to disciplinary action, up to and including termination of employment. <br /> Printed Name <br /> Signature <br /> Organization <br /> 10 <br />
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