I understand that my access to data, information, and records maintained in the manual and automated information and records systems of UK HealthCare (all hereinafter referred to as Information Systems) is limited to my need for the information in the performance of my job duties. UK HealthCare restricted information may include, but is not limited to, financial data, patient health information (PHI), personally identifiable information (PII), contract information, and data that results in a competitive advantage in the marketplace regardless of its form (i.e. paper, magnetic media, optical media, conversations, film, etc.).

The intent of this agreement and UK HealthCare policies is to assure that restricted information will remain confidential through its use, only as a necessity to accomplish the organization’s mission.

By my signature below, I affirm that I have been advised of, understand, and agree to the following terms and conditions of my access to information contained in Information Systems.

• My computer logon ID/password combination is equivalent to my LEGAL SIGNATURE and I will not disclose this password to anyone or allow anyone to access Information Systems using my logon ID/password combination.
• I will password protect and encrypt any portable electronic device that contains patient (or other restricted) information.
• I am responsible and accountable for all entries made and all retrievals accessed using my logon ID/password, even if such action was made by me or by another due to my intentional or negligent act or omission.
• I will not access any Information System using a logon ID/password other than my own.
• I will not access or request access to any information for which I have no responsibility. In addition, I will not look up my own medical information.
• If I have reason to believe that my logon ID/password has been compromised, I will immediately notify the Office of Corporate Compliance and the Director of Information Security.
• I will not disclose any restricted information unless required to do so in the official capacity of my employment or contract. I also understand that I have no right of ownership interest in any restricted information.
• I will comply with all policies and procedures and other rules of UK HealthCare relating to confidentiality of information and access.
• I understand that my use of the UK HealthCare Information Systems may be periodically monitored to ensure compliance with this agreement.
• I will dispose of restricted information properly in accordance with all applicable policies.
• If a Department standard is more restrictive than this agreement, I will abide by that Department’s standard.
• I agree not to use the information in any way detrimental to the organization and will keep all such information confidential.
• This agreement cannot be terminated or canceled, nor will it expire.
• I understand that if I violate any of the above terms, I will be subject to disciplinary action, including discharge, loss of privileges, termination, legal action, or any other remedy available

Students will be required to pay for a UK St. Claire badge now called a wild card. The cost of it will be $25 and will have door access. If you do not want door access the cost of it will be $5. 

Students have the option to use their program badge, if they choose to not purchase a badge. If they want door access, they will need to give us the 5-7 digit code called a proxy code that will be on the back of the badge at the bottom. If you do not have a proxy code, you will not be given door access. You are welcome to screen shot your badge and upload it for your photo as well or type in the number. 

I attest that I have read the information provided to me in the Student Orientation Overview literature.  I understand that I am responsible for the content in its entirety.  Furthermore, while on rotation at UK St. Claire or any of its facilities,I will uphold the values and follow the guidelines for acceptable behavior as described in the overview literature. By signing below, I acknowledge I have read and understand all information in the Student Orientation Overview. I understand that I can be dismissed from clinical rotation should it be determined that I did not follow the guidelines or policies defined in the overview. I acknowledge I can be asked to leave UK St. Claire immediately without cause. I have provided the Northeast KY AHEC and UK St. Claire  the Information listed below and is required prior to reporting to my rotation site. Failure to provide any information listed below will result in not participating in the rotation.

Please submit your documentation below.