WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
CONFIDENTIALITY AND NONDISCLOSURE ACKNOWLEDGMENT
Wake Forest University Baptist Medical Center and its affiliates and subsidiaries (collectively “WFUBMC”) creates,
develops, receives, maintains, transmits, and transacts confidential, proprietary, and trade secret information to
achieve its clinical, research, and educational missions (“Confidential Information”).
WFUBMC’s Confidential Information includes Protected Health Information (“PHI”), education records, fiscal records,
research records, computer system records, and other management information deemed confidential for business
purposes as further defined by WFUBMC’s Confidentiality of Information Policy or as specified in the agreement
WFUBMC has with you or your employer for your services.
During and in consideration of my engagement with WFUBMC, I understand, acknowledge, and agree to the
following terms of this Confidentiality and Nondisclosure Acknowledgment (“ Acknowledgment”):
1. I may be required to access, use, create, develop, receive, maintain, transmit, transact, and/or disclose
(collectively “Activity”) Confidential Information.
2. I will limit my Activity involving Confidential Information to what is necessary for me to perform my services and to
what is an appropriate, permitted, and approved purpose (collectively “Acceptable Purpose”). My Activity
involving Confidential Information will not be for any other purpose.
3. I recognize that any Activity that involves or relates to Confidential Information that is not for an Acceptable
Purpose is unauthorized (“Unauthorized”).
4. During and after my engagement, I will hold Confidential Information in the strictest confidence and will not
divulge any Confidential Information to any other firm, entity, institution, or person without proper authority.
5. My Activity may require me to share Confidential Information with WFUBMC employees, contractors, advisors,
consultants, and other WFUBMC approved resources or personnel and I will do so on an authorized “need to
know” basis only.
6. I recognize that Confidential Information constitutes a valuable, special, and unique asset of WFUBMC. I further
recognize and agree that all Confidential Information, in any physical, electronic, or other format, to which I am
exposed is the exclusive property of WFUBMC and shall be returned to WFUBMC, including all copies thereof,
upon termination of my engagement or as otherwise directed by WFUBMC.
7. I understand that, as part of my role and as related to my services, I may receive confidential information from
third-party individuals, providers, or entities, which may include confidential information available through (a)
Epic’s Care Everywhere; (b) federal, state, and other health information exchanges; and (c) other databases
(collectively “Third-Party Confidential Information”). I agree that my Activity involving or related to Third-Party
Confidential Information shall only be for an Acceptable Purpose and shall be conducted in accordance with the
terms of this Confidentiality Acknowledgment and WFUBMC’s policies and procedures. I agree to protect
Third-Party Confidential Information as I would WFUBMC’s Confidential Information under this
8. My Activity will abide by and follow WFUBMC’s applicable policies and procedures. Activities addressed under
such policies and procedures include but are not limited to the following:
I will not discuss Confidential Information in areas where others who do not have a need to know the
Confidential Information may overhear the conversation (e.g. hallways, elevators, cafeterias, shuttle
buses, public transportation, restaurants, and social events).
I will not engage in Activity involving or related to Confidential Information for other persons or employees
who do not have the authorization to access the Confidential Information themselves.
I understand that passwords and other security credentials are Confidential Information and as such will
not share them and will protect them as Confidential Information. I will inform my WFUBMC Sponsor