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DocuSign Envelope ID:92CA6B6A-5CBD-40AE-8FF1-B6100066874C <br /> ORANGE COUNTY HEALTH DEPARTMENT <br /> FY 2019-2020 <br /> Contracted Interpreters: Conditions of Contract Statement <br /> Confidentiality <br /> As a Contract Interpreter for Orange County Health Department(OCHD), I acbmowledge 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 the Immigrant/Refugee Health Program Manager for referral to the <br /> OCHD HIPAA Privacy and Security Officer. <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, I understand that I may be subject to prosecution.under Federal law if I <br /> coerce or endeavor to coerce any person to undergo an abortion or a sterilization procedure.I must also <br /> follow mandatory reporting requirements of child abuse, child molestation, rape, incest and human <br /> trafficking, and will seek assistance from the Clinic Manager and lmrnigrant/Refugee Health Program <br /> Manager if I have questions or concerns. <br /> As an Interpreter,my responsibility is to convey the message from the provider to the client to the best of my <br /> ability,without prejudice or personal bias. If I am present when an OCHD employee attempts to coerce a <br /> person to undergo an abortion or a sterilization procedure, I should discontinue interpreting, and report this to <br /> the Clinic Manager and Immigrant/Refugee Health Program 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. 'I understand that I may be asked to participate in <br /> emergency drills and exercises. As a Contractor, I do have the right to decline any of these special 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 any contract with a designated agency representative. <br /> Contractor Name: Li ssette Saca Date: 6/28/2019 <br /> GocuSigned by: <br /> Contractor Signature: S56, Sat Date: 6/28/2019 <br /> GocuSigned by: <br /> OCHD Representative: rt.�W' �rawW Date: 7/2/2019 <br /> 2F52C29B147F405 <br />