VA Loma Linda Healthcare System Statement of Commitment and Understanding As a volunteer of the Department of Veterans Affair (VA), I am committed to safeguarding the personal information that Veterans and their families have entrusted to the Department. I am also committed to safeguarding the personal information which VA employees and applicants have provided. I will contact the Chief, the Voluntary Services department, local Privacy officer, or information Security Officer when I am unsure of the appropriate protocol to gather, create, maintain, use, disclose, or dispose of information about Veterans and their families, VA employees and applicants. -Ensure documents containing private health information (PHI), or individually identifiable information (III) are put in the recycle bins and not trash receptacles. -Check fax and copying machines to ensure that documents containing PHI or III are not left there. -Log off the computer before walking away. -Know the Privacy Officer – -Know the Information Security Officer – -Alert your supervisor of apparent privacy and/or security violations. -Feel free to contact the privacy and/or security officer. I understand that if I fail to comply with applicable confidentiality statues and regulations, I may be subject to civil and criminal penalties, including fines and removal, for violation of applicable confidentiality and security statues, regulations and policies. I certify that I have read the information above and am committed to safeguarding personal information about Veterans and their families, VA employees, and applicants. _______________________ _______________________ ____________ Print Name Signature Date
VA Loma Linda Healthcare System Statement of Commitment and Understanding As a volunteer of the Department of Veterans Affair (VA), I am committed to safeguarding the personal information that Veterans and their families have entrusted to the Department. I am also committed to safeguarding the personal information which VA employees and applicants have provided. I will contact the Chief, the Voluntary Services department, local Privacy officer, or information Security Officer when I am unsure of the appropriate protocol to gather, create, maintain, use, disclose, or dispose of information about Veterans and their families, VA employees and applicants. -Ensure documents containing private health information (PHI), or individually identifiable information (III) are put in the recycle bins and not trash receptacles. -Check fax and copying machines to ensure that documents containing PHI or III are not left there. -Log off the computer before walking away. -Know the Privacy Officer – -Know the Information Security Officer – -Alert your supervisor of apparent privacy and/or security violations. -Feel free to contact the privacy and/or security officer. I understand that if I fail to comply with applicable confidentiality statues and regulations, I may be subject to civil and criminal penalties, including fines and removal, for violation of applicable confidentiality and security statues, regulations and policies. I certify that I have read the information above and am committed to safeguarding personal information about Veterans and their families, VA employees, and applicants. _______________________ _______________________ ____________ Print Name Signature Date
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