Appendix C

CONFIDENTIALITY AGREEMENT

UCLA HEALTH SYSTEM

It is the responsibility of all UCLA Health System workforce members, as defined above, including employees, medical staff, house staff, students and volunteers, to preserve and protect confidential patient, employee and business information.

The federal Health Insurance Portability Accountability Act (the "Privacy Rule"), the Confidentiality of Medical Information Act (California Civil Code § 56 et seq.) and the Lanterman-Petris-Short Act (California Welfare & Institutions Code § 5000 et seq.) govern the release of patient identifiable information by hospitals and other health care providers. The State Information Practices Act (California Civil Code sections 1798 et seq.) governs the acquisition and use of data that pertains to individuals. All of these laws establish protections to preserve the confidentiality of various medical and personal information and specify that such information may not be disclosed except as authorized by law or the patient or individual.

Confidential Patient Care Information includes: Any individually identifiable information in possession or derived from a provider of health care regarding a patient's medical history, mental, or physical condition or treatment, as well as the patients and/or their family members records, test results, conversations, research records and financial information. (Note: this information is defined in the Privacy Rule as "protected health information.") Examples include, but are not limited to:

• Physical medical and psychiatric records including paper, photo, video, diagnostic and therapeutic reports, laboratory and pathology samples;

• Patient insurance and billing records;

• Mainframe and department based computerized patient data and alphanumeric radio pager messages;

• Visual observation of patients receiving medical care or accessing services; and

• Verbal information provided by or about a patient.

Confidential Employee and Business Information includes, but is not limited to, the following:

• Employee home telephone number and address;

• Spouse or other relative names;

• Social Security number or income tax withholding records;

• Information related to evaluation of performance;

• Other such information obtained from the University's records which if disclosed, would constitute an unwarranted invasion of privacy; or

• Disclosure of Confidential business information that would cause harm to UCLA Health System.

Peer review and risk management activities and information are protected under California Evidence Code section 1157 and the attorney-client privilege.

I understand and acknowledge that:

1. I shall respect and maintain the confidentiality of all discussions, deliberations, patient care records and any other information generated in connection with individual patient care, risk management and/or peer review activities.

2. It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all medical records, proprietary ...