EMPLOYEE CONFIDENTIALITY AGREEMENT

AS REQUIRED BY HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

As an employee with Elm City Center you will have access to information related to our consumers and the business of Elm City Center. Illinois and U.S. law mandates that personal health information be kept confidential except under specific circumstances. Personal health information includes demographic, billing, and medical information about the consumer. The fact that someone is receiving care is also to be kept confidential. This information cannot be shared with others except for the purposes of treatment, payment, and health care operations or with the consent of the consumer or as provided by law.

Information related to the business of our practice is also confidential and proprietary.

This includes billing and employment information, business plans, and any information on the day-to-day operations of Elm City Center. This information may only be shared in the context of your work responsibilities.

As an employee, you agree that you will keep confidential the personal health information of our consumers and our business information. You understand that breaching confidentiality of the consumer’s personal health information is a violation of law, and could result in legal action. Additionally, breaching consumer confidentiality or the confidentiality of our business information may subject you to discipline, up to and including termination.

Your duty to keep confidential consumer and business information remains even after you are no longer employed by Elm City Center.

I acknowledge that as part of my training on confidentiality I was trained regarding Elm City Center’s policies and procedures related to Health Insurance Portability And Accountability Act (HIPAA).

I have read and understand the above Confidentiality Policy and recognize that a breach of the confidentiality of consumer or business information may result in discipline, up to and including, termination of employment.

Date:______________________

Name of Employee ______________________________