Third Party Confidentiality Statement

This statement is to be read, understood and signed by all third parties to include but not limited to janitorial services, courier services, storage and records destruction companies, attorneys, accounting and auditing firms, partners and other third party services.

It is the policy of Acadiana Computer Systems, Inc. to respect and protect the privacy rights of patients, clients, families, staff, and third parties. ALL information contained in medical records, staff files, computer banks/systems and hospital records of any kind is strictly confidential. In addition, any information about Acadiana Computer Systems, Inc., business, clients, families, staff or third parties (and/or agents thereof) which is disclosed or becomes known in the course of one’s contractual relationship or proposal for business services must be used solely for the purpose of evaluating or implementing the transaction or possible transaction and must be kept strictly confidential. All information must be destroyed according to proper procedure.

IT IS THE EXPECTATION OF ACADIANA COMPUTER SYSTEMS, INC. THAT ALL INDIVIDUALS THOROUGHLY UNDERSTAND THAT VIOLATION OF ANY ASPECT OF THIS POLICY WILL RESULT IN CORRECTIVE ACTION.

I understand that breach of this policy will be cause for corrective action, which may include termination of services and/or legal action.

I have read and understand the above statements and I will abide by the terms of the Business Associate Agreement signed by Business Entity.

Business Entity Name: ________________________________________

Name of Authorized Representative: ______________________________

Signature of Authorized Representative: ____________________________

Signature of Workforce Member (s) ________________________________

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Date: _____________________