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S D P I D i a b e t e s P re v e nti o n P r og ram a nd Hea lt h y H ear t P r oj ec t

Confidentiality statement Special Diabetes Program for Indians. S D P I D i a b e t e s P re v e nti o n P r og ram a nd Hea lt h y H ear t P r oj ec t.

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S D P I D i a b e t e s P re v e nti o n P r og ram a nd Hea lt h y H ear t P r oj ec t

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  1. Confidentiality statement Special Diabetes Program for Indians SDPIDiabetes Prevention Program and HealthyHeart Project • ThisisanexampleofthepolicysignedbyCenters for AmericanIndianandAlaskaNativeHealthstaffonan annual basis. You mayuseitasa templateif youwouldlike. • POLICYON CONFIDENTIALITY • ItisthepolicyandpracticeoftheCentersforAmericanIndianandAlaskaNativeHealth,ColoradoSchoolofPublic Health,andUniversityofColorado(UC)DenverAnschutzMedicalCampusthatallpersonalhealthinformationis heldinstrict confidence.Specifically, UCDenverAnschutzMedicalCampus, itsDepartmentsandProgramsare required to adhere to the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which protectspersonalhealthinformation.Personalhealthinformationisdefinedashealthinformationthatcontainsany of thefollowingidentifiers,andcanbeinanyform–oral,electronic,printorvideo. • Name • Postal address (geographicsubdivisionssmaller thanstate) • All elementsof datesexceptyear(birthdate,if over89,mustbeaggregated) • Phonenumber • Faxnumber • Email address • Social Securitynumber • MedicalRecordnumber • Healthplannumber • Accountnumbers • Certificate/Licensenumber • URL • IPaddress • Vehicleidentifiers (VIN/licenseplatenumber) • DeviceID • BiometricID • Full face/identifyingphoto • Anyotheruniqueidentifyingnumber,characteristic,orcode • HIPAAmandatesthatpersonalhealthinformationmaynotbeusedordisclosedexcept: 1)totheindividual;2)for Treatment,Payment,orHealthcareOperations(TPO);3)formandatoryreporting;or4)withanauthorization(e.g., signed consent/release form) and then only to those specifically authorized in the consent form to receive that information. • All data and other records containing personal health information are to be carefully safeguarded. Breach of confidentialityisdefinedasanyuseordisclosureofpersonalhealthinformationforanypurposeotherthannoted above.Ifsuchbreachofconfidentialityoccurs,inadvertentorpurposeful,itwillberegardedaswillfulmisconduct andmayresult indisciplinaryactionuptoandincludingdismissal. • UC Denver Anschutz Medical Campus requires that all employees be trained in the basic HIPAA privacy and security principles, and that employees who work with research data also be familiar with the HIPAA Guidance Document. In addition, all employees are required to sign this statement on an annual basis to reaffirm their understandingof thispolicy. • Ihave readthispolicyandunderstandandconcur. Signature Date Pleaseprintname DPHHIAEExampleof Staff ConfidentialityStatement.doc LastRevised:10/17/2013

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