Presentation on theme: "Holland Hospital Orientation for students, contractors and temporary employees."— Presentation transcript:
Holland Hospital Orientation for students, contractors and temporary employees
2 Welcome! Mission –To continually improve the health of the communities we serve in the spirit of hope, compassion, respect and dignity. Vision –In partnership with our medical staff, to be the pre-eminent stand- alone hospital in West Michigan as measured by benchmark customer service, business growth, financial performance and medical quality. Our Core Values –Customer Service – “Be There” –Commitment – “Choose Your Attitude” –Communication – “Make Their Day” –Creativity – “Play”
3 Introduction This presentation is intended to familiarize you with procedures and expectations while you are at Holland Hospital. The presentation will offer reading material on HIPAA, Infection Control and Needle Stick Safety.
4 Instructions Immediately following the slides for HIPAA and Infection Control, a quiz will be given. Please complete the quiz and then print completed quiz (please print only the quiz pages). Complete the Non-Employee Workforce Form and Non- Employee Service Provider Acknowledgement Form on slides at the end of this presentation and then print each. Call Human Resources at (616) to schedule a time to meet prior to starting your assignment at Holland Hospital. Please remember all required documentation for your appointment in Human Resources. Without it you may NOT begin your assignment. A checklist is provided at the end of this presentation to ensure you have all required paperwork.
5 HIPAA Training Self-Study Module
6 HIPPA Directions: Review the slide presentation. Complete the HIPAA quiz. Sign the HIPAA quiz. Be sure to print and sign your name; include the date and your department. Thank you!
7 The HIPAA Privacy Rule What You Need to Know
8 HIPAA What are the possible repercussions to the patient, to you, and to the hospital if confidentiality is broken?
9 What is HIPAA? HIPAA stands for Health Insurance Portability and Accountability Act, passed in It’s a federal law imposed on all health care organizations such as: –Hospitals, physician offices, home health agencies, nursing homes and other providers. –HMOs, private health plans and public payers such as Medicare and Medicaid.
10 HIPAA Components Portability and Accountability Its original goal was to make it easier for people to move from one health insurance plan to another as they changed jobs or became unemployed. This means they would be able to move their medical records and information more easily and to get the care they needed. The next component of HIPAA is Administrative Simplification. What does this mean?
11 HIPAA Components Another component is Administrative Simplification, intended to do the following: –Standardize formats, codes and IDs for the electronic transmission of health information. –Protect the security of electronic health data. –Protect the privacy of all health information.
12 HIPAA Components Administrative Simplification Before computerized records, it would have been difficult to remove many records and make use of this information. Today, with and electronic storage of information, thousands of records can be sent virtually anywhere in just a few minutes via a computer.
13 HIPAA Components Imagine you wanted to identify patients who had an expensive medical condition in order to discriminate against them. It would take countless hours to use paper records, but with a computer and standardized records, it’s simple to sort out patients who have expensive illnesses and potentially use that information to hurt their chances at getting jobs or insurance.
14 HIPAA Privacy Rule HIPAA is the first federal law protecting patients’ privacy and it gives patients certain rights to view their own medical records and restrict who sees their health records. Key concepts to remember: –HIPAA punishes individuals and organizations that fail to keep patient information confidential. –HIPAA gives patients federal rights to gain access. So what could happen if a patient’s privacy is violated?
15 Penalties for Breaking HIPAA Privacy Rules Criminal penalties: Maximum of 10 years in jail and a $250,000 fine for serious offenses. Civil penalties: Maximum fine of $25,000 per violation. Facility sanctions: See HR Policy – “Confidential Information” located on Holland Hospital’s internal website. (Could result in suspension or termination.)
16 Penalties for Breaking HIPAA Privacy Rules For instance: –Knowingly releasing patient information in violation of HIPAA can result in a one-year jail sentence and $50,000 fine. –Gaining access to health information under false pretenses can result in a five-year jail sentence and $100,000 fine. –Releasing patient information with harmful intent or selling the information can lead to a ten-year jail sentence and $250,000 fine.
17 Penalties for Breaking HIPAA Privacy Rules Civil: Civil penalties are fines up to $100 for each violation of the law per person, up to a limit of $25,000 for each identical requirement.
18 Section VII: Employment Realities Holland Hospital Standards of Conduct: I understand that Holland Hospital employees are expected to conduct their duties in a manner that meets the highest legal and ethical standards. I agree that I will comply with all applicable laws, regulations, programs requirements and standards of ethical conduct as described in the HH Standards of Conduct. I also certify that I will report any known or suspected violations of these Standards of Conduct to the Corporate Compliance Officer immediately and without concern for retaliation or retribution for doing so. Confidentiality: I am aware that authorization to access computer systems at Holland Hospital also allows me access to confidential information. I certify that I understand that it is my responsibility to keep in strict confidence all information I encounter and will not discuss, disclose or disseminate such information to unauthorized persons. I specifically understand that information regarding patients, employees and individuals affiliated with Holland Hospital is not to be accessed by individuals who do not have a need to know this information. I recognize that unauthorized release of confidential information may make me subject to civil action under the provision of state and federal codes and regulations governing the confidentiality of patient specific health care information. In addition, any such breach of confidentiality will be reported to licensing and professional organizations as appropriate.
19 Myths about HIPAA When the privacy rule was released, many people worried that hospitals would have to take extreme measures to make sure no one overheard any Protected Health Information (PHI). The Department of Health and Human Services has released statements assuring the health care industry that such actions are not necessary. Let’s take a closer look at some of these myths.
20 Myths about HIPAA Myth: Hospitals cannot put patient names outside their doors or use white boards. White boards and patient nameplates are acceptable as long as a patient’s health information isn’t in plain view for someone passing by. Problems arise when patients’ names are linked to their conditions. If patients’ names are listed next to their condition on a white board, the board must be kept away from view.
21 Myths about HIPAA Myth: Doctors and nurses can go to jail for honest mistakes. There are certainly serious penalties – including jail times and huge fines – for health care workers who intentionally violate patient privacy by selling information to a marketing company or purposely looking up information about patients they're not treating. However, mistakes such as accidentally grabbing the wrong file will not result in serious sanctions. Now let’s look at what information is considered confidential information.
22 What is Confidential? It’s not just one piece of Protected Health Information (PHI) by itself; it’s two or more pieces of information that might identify a person and their health information – a key concept to remember. What are acceptable uses of confidential information?
23 Acceptable Uses of Confidential Information Health care providers are permitted to share and disclose Protected Health Information (PHI): - For treatment, payment and health care operations – a key concept to remember - For other reasons if they obtain permission from the patient
24 Treatment, Payment and Health Care Operations Health Care Operations: Physicians and quality control directors review confidential information to make sure patients are getting good care. All members of the workforce at a hospital contribute to the quality of care, but that doesn’t mean everyone needs to see health information about patients. This is termed as the “Minimum Necessary Requirement.” Let’s review what this KEY phrase means to you.
25 The Minimum Necessary Requirement HIPAA calls on health care workers to use the minimum amount of patient information they need to do their jobs efficiently and effectively – a key concept to remember. Ask yourself: - Do I need this information to do my job and provide good patient care? - What is the least amount of information I need to do my job?
26 Do You Need to Know? Coders and billers need to look at certain portions of records to code and bill correctly. Housekeeping staff do not need to look at patient records at all. If it’s not for treatment, payment, or health care operations, patient authorization is necessary to use or disclose Protected Health Information.
27 Authorization Facilities must obtain authorization from patients before using or sharing their Protected Health Information (PHI) for reasons other than treatment, payment or health care operations Reasons include: - Research- Some types of fundraising - Marketing- Attorney
28 Authorization It’s important that patients understand how they can protect their own health information and how providers protect their information. That’s why the HIPAA rule requires health care providers to post notices telling patients how their information will usually be used. Let’s take a look at some common sense ways that you can protect patients’ privacy.
29 Protect Patient Privacy Don’t leave patient records lying around. It would be easy for a patient or other staff member to look at the papers openly lying on a desk or counter.
30 Protect Patient Privacy Do close curtains and speak softly when discussing treatments in semi-private rooms. Be aware of who is around when you’re discussing patient care, and use common sense to protect confidentiality by taking simple steps such as lowering your voice or moving to a more secluded area of a room.
31 Protect Patient Privacy Do log off the computer when you’re finished. When using any computer system that contains Protected Health Information, log off when you are finished. Do not leave the information visible on an unattended computer monitor.
32 Rules for Faxing Patient Information When sending a fax: Always use a fax cover sheet. Call intended recipient before sending the fax. That way, they will be ready for the fax. Double check the fax number before sending it. It’s critical when faxing PHI that we do everything we can to ensure that the fax is going to the right person. If ever in question, ask the manager for assistance.
33 Rules for Using Computers Keep your passwords a secret. Although computers have greatly improved the efficiency of health care delivery, they have also increased the risk that large amounts of private information could be sent to the wrong person, computer or website with one keystroke. –For instance, a Midwestern university mistakenly posted children’s psychiatric records on a public website. –Another example, a hospital accidentally revealed the names of organ donors to the recipients in a computer- generated letter.
34 Rules for Using Computers Do not log into the system using someone else’s password or computer key. Passwords should never be given out, and they should not be written down. Passwords and other security features are put in place to protect patient information. If you share passwords, you may be held responsible for another worker’s inappropriate use of records.
35 Rules for Using Do not open attached files from unknown sources; this may open the door for viruses and hackers. Do not use work for personal matters.
36 Rules for Using Double check the address line of the message before you send it to make sure it’s going to the right person. Do not use to send patient’s Protected Health Information (PHI). Only use the internal mail system provided by the Protected Health Information program.
37 Patient Rights Patients have the right to: –View and keep a copy of the facility’s Notice of Privacy Practices (this notice will be made available at the time of registration). –Request restrictions on disclosures of PHI for treatment, payment and health care operations. –Receive an accounting of disclosures not for treatment, payment or health care operations.
38 Patient Rights Patients have the right to: –Inspect and copy their own health information. –Request amendments to information in their medical record. –Request preferred method of contact.
39 Patient Rights: Notice of Privacy Practices - This notice will be posted in main patient areas, off-site locations and on Holland Hospital’s internal website. - It will be offered to all patients at the time of registration and will be available to any individual who requests one from Patient Relations.
40 Patient Rights: Request for Restrictions on Disclosures Patients must agree to let facilities use PHI for treatment, payment and health care operations, but patients can request that they limit the use. For example, a patient knows a lot of Holland Hospital’s staff personally. He/she may request that his/her record not be chosen for quality review, or could ask that we do not use or disclose information about a previous surgery.
41 Patient Rights: Viewing and Copying Information Patients have the right to view and copy their Protected Health Information (PHI). This may include information stored on computer (e.g., their medical and business records). Patients may contact Medical Records for a copy.
42 Patient Rights: Requests for Amendments Patients may think the information contained in their medical record is incomplete or inaccurate and may request an amendment for as long as the information is kept by or for the hospital.
43 Patient Rights: Patient Directory When patients are at the hospital, they are put in the directory so that visitors can inquire about them. Patients may opt out of appearing in the directory. If they have opted out, no information can be given to the visitor or caller. For patients who do not opt out, staff can tell visitors or callers who ask for the patient by name the following: The patient’s location in the facility. The patient’s general condition (e.g., stable, good, fair). At the time of registration, the patient will be given the option to opt out of the directory.
44 Patient Rights: Patient Directory Don’t: –Give out a patient’s location or condition without making sure the patient is listed in the directory. –Disclose patient information other than location and general condition. –Say anything about a patient who has opted out of the directory, including confirming if the patient is here or not. If the patient’s privacy is violated, you may direct the patient to Patient Relations ( ). You may also call Patient Relations if you know or suspect breaches of confidentiality.
45 Corporate Compliance The main purpose of the program is to create a work culture that is compliant with legal and ethical standards and a way for you to anonymously report inappropriate activities (e.g., The Corporate Compliance Hotline). Standards are set by authorities such as the OSHA, CMS, Medicare, Medicaid, Federal (e.g., HIPAA), state, local governments and Holland Hospital’s own standards and policies (Standards of Conduct). An important part of keeping the trust of our patients and our community is to follow the laws and guidelines established by outside agencies and our own organization. Example: Maintaining patient confidentiality and reporting breaches in confidentiality. Compliance is the responsibility of ALL staff members, regardless of their positions or job responsibilities.
46 Key Concepts to Remember Minimum necessary – HIPAA calls on health care workers to use the minimum amount of patient information they need to do their jobs efficiently and effectively (e.g., for treatment, payment and/or health care operations). We have a legal and ethical obligation to protect patient privacy and rights.
47 Next Step Complete HIPAA quiz on next two slides. Print off your completed quiz and take to Human Resources (make sure to only print the pages containing the quiz).
49 HIPAA Quiz If you suspect someone is violating Holland Hospital’s Confidentiality policy(s), you should: –Say nothing – it’s none of your business –Watch the individual involved until you have gathered solid evidence against him or her –Report your suspicions to your supervisor or call Holland Hospital’s anonymous Compliance Hotline (616) and complete an Occurrence Report (orange form) Only employees who care for patients need to be concerned with protecting patient privacy and confidentiality. True or False HIPAA gives patients certain rights to view their own medical records and restrict who sees their health records. True or False What kind of personally identifiable health information is protected by HIPAA’s Privacy Rule? –Written –Electronic –Spoken –All the above In addition to regulating your own behavior with regard to confidentiality, you are responsible for monitoring the behavior of others, including physicians, co-workers, volunteers, visitors and patients. True or False Print Name:________________________________________Date:__________________________ Signature:__________________________________________Department:____________________
50 Infection Control Holland Hospital Infection Control
52 Who and Where is Infection Control? Infection Control is under the Quality Department Located at the 24 th Street building Infection Control Medical Director: Dr. Shannon Walko, D.O. Available on-site, Monday-Friday, 8:00 a.m.-4:30 p.m. Amy Lyons, RN, MS, CIC (ext. 4201) Available by pager 24/
53 Infection Control Questions or Concerns? When you are at the hospital… Our policies are located on the hospital’s internal website. The Infection Control section of the Hospital Policies and Procedures is Chapter 16. This chapter includes: The Bloodborne Pathogen (BBP) Exposure Control Plan (16.3). Isolation Policies. If you do not have direct access to the internal website, please contact your direct supervisor for assistance. OR Feel free to contact the Infection Control Coordinator (in person 8:00 a.m.-4:30 p.m., Monday-Friday, or by pager 24/7). or The Patient Care Coordinators (PCC) are available 3:00 p.m.-7:30 a.m. daily. The PCC pager number is
54 History of the Final Standard December 6, 1991 – Federal Register is where the final standard was originally published. It was created due to complaints of federal unions for their health care employees. Michigan OSHA and Federal OSHA BBP Standards are both available at any time by contacting infection control coordinator.
55 What are Bloodborne Pathogens? Human Immunodeficiency Virus (HIV) Hepatitis B Other bloodborne diseases include: Hepatitis C
56 High Risk Fluids for Bloodborne Pathogens Blood Blood by-products Unfixed tissue or organs Semen Vaginal secretion Amniotic fluid Cerebrospinal fluid Peritoneal fluid Pleural fluid Pericardial fluid Synovial fluid Saliva in dental procedures Any body fluid visibly contaminated with blood Any body fluids which are difficult or impossible to differentiate from body fluids
57 Hepatitis B Etiologic agent : Hepatitis B virus Clinical Features: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting Transmission: bloodborne, sexual and perinatal
58 Hepatitis C Hepatitis C is a liver disease caused by the Hepatitis C virus (HCV) which is found in the blood of persons who have this disease. The infection is spread by contact with blood of an infected person.
59 How Serious is Hepatitis C? Hepatitis C is unpredictable; it can be serious for some and not for others. Most people who get infected carry the virus for the rest of their lives. Complications from chronic Hepatitis C can include cirrhosis, which can lead to liver failure later in life.
60 Risk Factors Associated with the Transmission of HCV Transfusion or transplant from infected donor Injecting drug use Hemodialysis (years on treatment) Accidental injuries with needles and sharps Sexual/household exposure to anti-HCV-positive contact Multiple sex partners Birth to HCV-infected mother
61 Hepatitis C Virus is NOT Spread by: Breast feeding Sneezing Hugging Coughing Sharing eating utensils or drinking glasses Food or water Casual contact
62 Human Immunodeficiency Virus (HIV) AIDS is caused by the human immunodeficiency virus (HIV). As of December 2001, Center for Disease Control has received reports of 57 documented cases and 138 possible cases of occupationally acquired HIV infection among health care personnel in the United States since reporting began in The average risk of HIV infection after a needle-stick injury or cut exposure to HIV infected blood is 0.3% (1 in 300). Stated another way, 99.7% of needle-stick/cut exposures do not lead to infection. Reference: Exposure to Blood from CDC published in July 2003
63 HIV Transmission Sexual Perinatal Blood to blood exposure Blood to mucous membrane exposure It is NOT spread by: Casual contact or through insect bites or stings
64 Where is the Bloodborne Pathogen Exposure Control Plan? The Exposure Control Plan is located on the hospital’s internal website under Chapter 16. If you do not have direct access to the hospital’s internal website, please contact your direct supervisor for assistance.
65 What is Contained in the Exposure Control Plan? Risk classification of all jobs within the organization Types of personal protective equipment are to be utilized and when Defines standard precautions Blood and body fluid exposure follow-up Biohazard signage or color coding Hand hygiene
66 Hepatitis B Vaccine – Did You Know? Three injection series: given first injection; one 30 days later and then five months following the second injection. 90 percent will develop serum antibodies. Antibody testing should occur six weeks to three months following last injection. If an employee of a health care facility that requires Hep B chooses not to participate upon employment, they must sign a formal declination and may choose later to receive injections.
67 Regulated Waste Medical waste was discovered on the Lake Michigan shore in 1988 which led to the enactment of the Medical Waste Regulatory Act of This act controls the handling, storage, treatment, transportation and disposal of medical waste from its generation to ultimate disposal.
68 Biohazard Labeling
69 Medical Waste Labeling Warning labels are affixed to containers of regulated waste, refrigerators and freezers that contain blood body fluids and containers that are used to store or transport blood or body fluids. Red bags or red containers may be substituted for labels. Laundry is NOT medical waste and is never placed in a red bag.
70 What to Do in Case Of a Blood or Body Fluid Spill Always wear the personal protective equipment appropriate to the size of the spill. Never pick up glass fragments by hand; always use dustpan and broom or forceps, etc. Absorb fluid with either absorbent towels or powders. Area must be disinfected with approved disinfectants. Housekeeping will assist during hours 0600 to midnight. After hours, a spill kit located in the housekeeping closets or soiled utility rooms.
71 Other Information… Personal protective equipment Available in clean storage rooms, isolation carts Goggles available in clean storage areas Disinfectant wipes available for reusable equipment (stethoscopes, glucometers, etc.) Located on isolation carts and dirty utility rooms
72 Blood or Body Fluid Exposure If you get a needlestick or blood or body fluid exposure: Wash area with soap and water (exception: eyes or mouth – use only water). Notify the Infection Control Coordinator or Patient Care Coordinator: Page either the Infection Control Coordinator ( ) or Patient Care Coordinator after- hours ( ) Complete necessary paperwork (available through Infection Control Coordinator/Patient Care Coordinator): Employee illness and injury report (ask supervisor for report)
73 What Happens if You Have a Bloodborne Pathogen Exposure? If we know whose blood you were exposed to: Lab draws for HIV/Hepatitis B and C on that person (not you). We notify you of their HIV results that day. The hepatitis labwork comes back within a week. If we do not know the source of the blood: We will send you to either Med 1 or ED (after-hours) immediately for care: You may be offered testing Determine risk Consultation on meds and treatment options
74 Our Isolation Procedures Standard Precautions Transmission-Based Precautions Contact Contact-PLUS Droplet Airborne Neutropenic * Not CDC based precaution
75 Standard Precautions Use on Every Patient, Every Time Standard precautions must be followed even if transmission-based (the colored signs) isolation is in place.
76 Our Transmission-Based Isolation Signs
77 Contact Isolation Yellow sign Any contact with patient or objects that patients may have contact will spread these organisms Equipment: Gloves Gown Diseases: C.difficile Scabies Lice
78 Contact Plus Green sign (Not officially a Center for Disease Control transmission-based precaution) Other health care facilities will not use this term. Specific only to Holland Hospital. Any contact with patient or objects that patients may have contact will spread these organisms Equipment needed: Gown and gloves Surgical mask if within three feet of the patient Diseases: MRSA and VRE
79 Droplet Orange sign Equipment needed: Surgical mask within three feet of the patient Diseases: Influenza Pertussis Bacterial meningitis
80 Rules for the N-95 Respirator Mask Disposable Can be used up to 8 hours if not soiled or misshapen for TB. Exception: use only once and replace during a pandemic flu, SARS, etc. Store the mask Paper bag Label with your name on the bag or elastic strap
81 Airborne Isolation Red sign Need a negative-pressure room Both doors (inner and outer) must remain closed. Bioengineering must inspect airflow daily when patient present. Equipment needed: N-95 respirator mask Diseases: Tuberculosis SARS/Avian Flu Chicken Pox/Measles
82 Neutropenic Precautions Neutropenia is a blood condition in which the patient white blood cells are abnormally low. Patients with neutropenia are more susceptible to bacterial infections. Blue sign (does not state neutropenic since this is a diagnosis). A mask is required if you are going to be within three feet of the patient. Good hand hygiene!
83 Handwashing Handwashing remains the cornerstone of all preventative measures. Our policy Hand Hygiene is (If you do not have direct access to the hospital’s internal website, please contact your direct supervisor for assistance.) Our policy is Wash in … Wash out! Handwashing with soap and water is ideal; however, in times when these are not available waterless degermers are acceptable. –10-15 seconds of scrubbing in order to be most effective. –Lots of hand jewelry and very long nails can harbor germs, puncture gloves and get in the way of good handwashing. Only Holland Hospital hand lotion may be used.
84 Handwashing – The #1 Way to Maintain Infection Control Soap and water: Visibly dirty, soiled (with or without gloves) “Feel” sticky, sweaty or dirty After using the restroom Before eating Alcohol-based waterless hand sanitizer: Before/after contact with patients Before/after putting on gloves If moving from a contaminated body area to a clean area After touching dirty or contaminated environmental surfaces
85 For Questions or Concerns… Please contact Infection Control at or pager (24/7). After business hours or on weekends, for in-person assistance the Patient Care Coordinator (PCC) can assist you.
86 Next Step Complete the Infection Control Quiz on next four slides. Print off your completed quiz and take to Human Resources (make sure to only print the pages containing the quiz).
87 Infection Control Quiz Circle the best answer TRUE FALSE Standard precautions apply to all patients with any diagnosis. TRUE FALSE Hand washing is not required between patient contacts if you wear good quality gloves. TRUE FALSE Hand hygiene is the most important defense against the spread of infection. TRUE FALSE Infection Control policies and procedures are located on Holland Hospital’s internal website under Policies and Procedures, Volume TRUE FALSE Patient care equipment can be a source of infection for the patient and the staff.
88 Infection Control Quiz (page 2) TRUE FALSE Report an exposure incident at least two days after it happens. TRUE FALSE If you don’t work directly with patients, you don’t need to be concerned about infection control. TRUE FALSE Report an exposure incident by sending an e- mail message to Infection Control. TRUE FALSE Contact precautions prevent the spread of pathogens through physical contact. TRUE FALSE Tuberculosis is a disease that requires airborne precautions in a negative pressure room (a room with an ante-room).
89 Infection Control Quiz (page 3) TRUE FALSE A regular surgical mask can be worn when entering a room of a known or suspected tuberculosis patient. TRUE FALSE When a TB patient is cared for in a negative pressure room, only the inner door of the ante-room needs to be kept closed. TRUE FALSE When a patient requires airborne, droplet, or contact precautions, you don’t need to follow standard precautions. TRUE FALSE Lots of hand jewelry and very long nails can harbor germs, puncture gloves and get in the way of good hand washing. TRUE FALSE Alcohol-based hand rubs can be used for hand hygiene instead of soap and water hand washing, unless hands are visibly soiled.
90 Infection Control Quiz (page 4) TRUE FALSE Infection Control is everyone’s shared responsibility. Employee Signature:_____________________________ Date:________________ Print Name:______________________________________________ Department/Job Title:______________________________________
91 Once Slide Orientation is Complete Complete the Non-Employee Workforce Form and Non-Employee Service Provider Acknowledgement Form on the following slides. Print both of the above documents. Call Human Resources at (616) to schedule a time to meet prior to starting your assignment at Holland Hospital. Please remember to return all required documentation for your appointment to Human Resources. Without it you may NOT begin your assignment.
92 Non-Employee Workforce Form Name: Position: Address: Phone: Licensure or certification type (if applicable): Licensure or certification number (if applicable): Department you will be working: Reporting to: Assignment start date: Assignment end date: Employer/school: Employer/school contact: Employer/school phone: Please circle type of provider: Student/InstructorContract-ClinicalContract Non-Clinical
93 Non-Employee Service Provider Acknowledgement Form Confidentiality Statement I realize that in the course of my work at Holland Hospital, I may be exposed to confidential patient health information. I understand that I have no right or ownership interest in any confidential information. Additionally, I will limit my exposure to confidential patient health information and will treat this information, regardless of how it was obtained, with utmost discretion. I am required to conduct myself professionally and in strict compliance with applicable laws including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and Holland Hospital policies governing confidential information. I understand that a breach in confidentiality may result in immediate discontinuation of our agreement and/or legal action against me and/or the business I represent. I recognize that unauthorized release of confidential information may make me subject to civil action under the provisions of State and Federal codes and regulations governing the confidentiality of patient-specific health care information. In addition, any such breach of confidentiality will be reported to licensing and professional organizations, as appropriate.
94 Non-Employee Service Provider Acknowledgement Form Acknowledgement I have reviewed the Non-Employee Service Provider Safety Information Sheet or the "What You Need to Know" booklet and agree to comply with all Holland Hospital policies and procedures. Service Provider Name (please print your name)___________________________________________ Department/Unit__________________________________ Your signature___________________________________ Last four digits of Social Security Number_________ Print this page and take to Human Resources.
95 IMPORTANT Please take the following with you for your appointment in Human Resources. You MUST have all required and completed paperwork prior to starting at Holland Hospital. –Non-Employee Workforce Form –Non-Employee Service Provider Acknowledgement Form –Completed HIPAA Quiz (print once completed) –Completed Infection Control Quiz (print once completed) –TB test results within one year –Immunization records or records of Hepatitis History & Titer, MMR Titer, Varicella Titer –Current CPR for all clinical positions –Other documentation may be required for certain positions
96 You Are Finished!! Checklist to bring to Human Resources: –Current TB Test –Record of Immunizations –CPR (if applicable) –Current licensure/certification (if applicable) –Printed Non-Employee Workforce Form –Printed Non-Employee Service Provider Acknowledgement Form –Printed HIPAA Quiz –Printed Infection Control Quiz