Use of Information Systems Agreement
Page 1 of 1
Document No.: 13243
Version #1
Employee Details
Name of Employee
Nurse Maude (NM) agrees to grant me access to information systems relevant to my area of employment. Where
these systems contain confidential client / employee information, I agree to the following provisions:
1. I acknowledge that through its system, I may obtain confidential patient, clinical, and employee-related
information, and confidential information about the business and financial interests of NM (collectively
referred to as "Confidential Information"). I understand that this Confidential Information is protected by
legislation, as well as the policies and procedures at NM. I agree to comply with all applicable laws regarding
the privacy and security of health information and with all existing and future NM policies and procedures
concerning Confidential Information.
2. I agree to access Confidential Information only for those individuals whose care I am coordinating, managing
or providing. I also agree to access only the amount of Confidential Information necessary to perform my
job functions related to my work. Any other access requires the express permission of NM.
3. I agree that I will never access Confidential Information for "curiosity viewing." I understand that this
includes viewing Confidential Information of children, other family members, friends, or co-workers, unless I
have a treatment relationship with those individuals.
When using Electronic Information Systems:
4. I agree not to release my User ID and password to any other person and I agree not to allow anyone else to
access or use the Information System under my User ID and password. I understand that when I am assigned
a User ID and password to access the Information System, this is the equivalent of my signature and that I
am fully responsible and will be held accountable for all activity performed under my User ID. I agree not to
use or release anyone else’s User ID or password.
5. I agree not to allow any unauthorized person to use or access the Information System. I agree not to allow
unauthorized staff members, my family, friends or other persons to see Confidential Information on my
computer screen while I am accessing the Information System.
6. I agree to notify the NM Help Desk immediately if I become aware or suspect that another person has access
to my User ID or password, or I think Confidential Information is being accessed or shared improperly.
7. I understand that my phone calls may be recorded and accessed in accordance with the Call Recording and
Access procedure. This may include personal calls which should be kept to a minimum
8. I agree that my compliance with this Agreement may be audited by NM. I agree to cooperate with any audit
conducted by NM.
9. I understand that NM can suspend my service pending investigation of potential breaches.
10. I agree that, in the event I breach any provision of this Agreement, NM has the right to terminate my access
and to refer the matter to my line manager as a breach of confidentiality as defined in the Staff Handbook,
with or without notice at NMs discretion. I also acknowledge that my employment may be terminated and
that I and my employer may be subject to penalties or liabilities under law as the result of security breaches.
Employee Signature ...................................................................... Date …../……/…..
*includes both paper based and electronic systems