HIPAA Acknowledgment for University Partners

NEW USER OR ANNUAL RENEWAL FOR THE UNIVERSITY OF NEBRASKA FOUNDATION 

CONFIDENTIALITY AND PROPRIETARY ACKNOWLEDGMENT

I acknowledge that University of Nebraska Foundation’s (“Foundation”) donor databases and related paper and electronic resources (“Protected Information”) is confidential and proprietary.  Protected Information includes, but is not limited to, certain donor, gift and fund information maintained in furtherance of the Foundation’s development activities.  It is the property of the Foundation and/or its Affiliates, the University of Nebraska-Lincoln Alumni Association, University of Nebraska at Omaha Alumni Association, University of Nebraska at Kearney Alumni Association, University of Nebraska Medical Center Alumni Association and The Nebraska Medical Center, referred to herein individually as “Affiliate” or collectively as “Affiliates.”  If I access this information, I agree to abide by the following terms:

1. The Protected Information is and shall remain confidential and proprietary.
2. The Protected Information is and shall remain property of the Foundation and/or appropriate Affiliate.
3. Protected Information relating to The Nebraska Medical Center is separate from any agreement between the University of Nebraska and the Foundation regarding private major gift cultivation, solicitation and stewardship.
4. I agree I will only access the Protected Information I need for my constituency’s advancement purpose (“Advancement Purpose”).
5. I understand if I encounter Protected Information beyond my Advancement Purpose, I will disregard the extraneous Protected Information.  For example, I may encounter the Protected Information of an Affiliate that is unrelated to my Advancement Purpose.
6. The Protected Information may not be copied, downloaded, placed or stored in a retrieval system, further transmitted or otherwise reproduced, stored, disseminated, transferred, used or communicated in any form or by any means to any person or entity unless the Foundation or appropriate Affiliate has given prior authorization.
7. The Protected Information shall not be used for commercial, political or any other non-authorized purpose.
8. I agree to maintain all electronic devices I use to access the Protected Information in a secure manner that does not compromise the confidential and proprietary nature of this Protected Information or permit access by any unauthorized third party.
9. I acknowledge that all Protected Information is protected by the Electronic Communications Privacy Act of 1986 (18 U.S.C. § 2701, et seq.).  I further acknowledge that all Protected Information is considered to be a trade secret under Neb. Rev. Stat. § 84-712.05(3).  I agree to actively pursue the protection of Protected Information as it is afforded by law.
10. I agree that I shall not disclose this information to any unauthorized third party, or use for personal gain, any Protected Information acquired from the Foundation or Affiliate.
11. I understand that access to Protected Information is a privilege and that unauthorized disclosure of Protected Information may be grounds for termination of this privilege, in addition to civil or criminal legal actions under local, state or federal law.
12. I understand that my access to Protected Information will be monitored to ensure my use of Protected Information is appropriate and within the scope of my Advancement Purpose.
13. I understand that Protected Information may include “Protected Health Information” or “PHI” as defined under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  PHI includes both demographic information such as name, contact information and giving information, as well as information about the individual’s health, care or payment for care.  HIPAA imposes restrictions on how PHI is used and disclosed.  I have completed the required HIPAA Training, and I have read, understand, and agree to abide by, the Foundation’s HIPAA Policies and Procedures that apply to me.