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• 4 <br /> 1,4 <br /> ATTACHMENT 1 <br /> Agency Agreement on Nondisclosure of Confidential Information <br /> This form is for Agencies and other non-County employees. G' <br /> "Confidential Information means information that is exempt from disclosure to the public or other unauthorized persons <br /> under Chapter 42.56 RCW.or other federal or state laws. Confidential Information includes, but is not limited to, protected <br /> health information as defined by the federal rules adopted to implement the Health Insurance Portability and Accountability <br /> Act of 1996,42 USC§1320d(HIPAA), and Personal Information. <br /> "Personal Information"means information identifiable to any person, including, but not limited to, information that relates to <br /> a person's name, health, finances, education, business, use or receipt of governmental services or other activities, <br /> addresses, telephone numbers, social security numbers, driver license numbers, other identifying numbers, and any <br /> financial identifiers. <br /> REGULATORY`REQUIREMENTS:'AND EITALT1ES = O <br /> State laws(including RCW 74.04.060 and RCW 70.02.020)and federal regulations(including HIPAA Privacy and Security <br /> Rules; 42 CFR, Part 2; 45 CFR Part 431) prohibit unauthorized access, use, or disclosure of Confidential Information. <br /> Violation of these laws may result in criminal or civil penalties or fines. You may face civil penalties for violating HIPAA <br /> Privacy and Security Rules up to$50,000 per violation and up to$1,500,000 per calendar year as well as criminal penalties 3 <br /> up to$250,000 and ten years imprisonment. <br /> In consideration for Snohomish County granting me access to County property, systems, and Confidential Information, I <br /> agree that I: <br /> 1. Will not use, publish, transfer, sell or otherwise disclose any Confidential Information gained by reason of this <br /> Agreement for any purpose that is not directly connected with the performance of the contracted services except as <br /> allowed by law. <br /> 2. Will protect and maintain all Confidential Information gained by reason this Agreement against unauthorized use, <br /> access, disclosure, modification or loss. <br /> 3. Will employ reasonable security measures, including restricting access to Confidential Information by physically <br /> securing any computers, documents, or other media containing Confidential Information. <br /> 4. Have an authorized business requirement to access and use County systems or property, and view its data and <br /> • Confidential Information if necessary. <br /> 5: Will access, use and/or disclose only the "minimum necessary" Confidential Information required to perform my <br /> assigned job duties. <br /> 6. Will not share County system passwords with anyone or allow others to use the County systems logged in as me. <br /> 7. Will not distribute,transfer or otherwise share any County software with anyone. <br /> 8. Understand the penalties and sanctions associated with unauthorized access or disclosure of Confidential Information. <br /> 9. Will forward all requests that I may receive to disclose Confidential Information to my supervisor for resolution. <br /> 10. Understand that my assurance of confidentiality and these requirements do not cease at the time I terminate my <br /> relationship with my employer or the County. <br /> FREQUENCY OF EXECUTfON AND DISPOSITION INSTRUCTIONS <br /> This form will be read and signed by each non-County employee who has access to Confidential information and updated <br /> at least annually. Provide the non-County employee signor with a copy of this Assurance of Confidentiality and retain the <br /> original of each signed form on file for a minimum of six years. <br /> `SIGNATURE <br /> PRINT/TYPE NAME NON-COUNTY EMPLOYEE'S SIGNATURE DATE <br /> Attachment 1 <br /> BRA-2018-101-198 <br /> City of Everett <br /> Page 13 of 13 <br /> 69 <br />