I understand. This agreement applies to the use of Ark ICT systems regardless of location. • There is a presumption that emails, voice messages and data are stored on Ark equipment for business purposes. This information will be filtered and monitored, and may be accessed to meet business needs. I will not: • Do anything that may compromise the safety of children or staff. • Disclose my username or password to anyone else. • Try to use any other person’s username and password for any purpose. • Do anything offensive that might bring the school or the Ark into disrepute. • Access, copy, remove or alter any other user’s files without their explicit permission. • Engage in any on-line activity that may compromise my professional responsibilities. • Attempt to install programmes on a machine, or store programs on equipment unless approved by school or Ark management. • Try to circumvent security settings or content filters. • Deliberately breach anyone’s copyright. I will: • Bring to the attention of the ICT Department or a member of the Senior Leadership Team any ICT activity or material that may be inappropriate or harmful. • Report any damage or faults involving equipment or software, however this may have happened, as soon as reasonably possible. • Only use chat and social networking sites in accordance with the school’s and Ark’s policies. • In order to protect both pupils and staff, I will only communicate with pupils using Ark email, work phones, and other school communication systems, but not personal phones, email, or social media, except in an emergency. • As far as is possible, use Ark provided systems to communicate with parents on school and pupil matters. I will maintain professional standards of conduct if I communicate with parents socially using personal phones, email or social media. Information Security I understand that I may have access to sensitive information about colleagues, families or pupils in our care. I will comply with the Ark guidance on data protection and will keep sensitive information within the Ark network. I will not send sensitive information via personal email accounts (Hotmail, Gmail etc.) or store it on: • Un-encrypted USB sticks • Personal devices (phones, laptops) or • ‘Cloud storage’ (SkyDrive, iCloud) • Email links and attachments: o Be ultra-cautious with email. o If you were not expecting it, then be suspicious o Do not open attachments unless you were specifically expecting them o Do not click on links outside of your organis...
I understand. The terms of this agreement are subject to change upon written notice to my Agency by HCSC, and may be terminated at any time and for any reason by either my Agency or HCSC. This agreement will be automatically updated by HCSC at its discretion based on changes to applicable laws, regulation, and/or changes to HCSC policies and procedures. This agreement will be automatically terminated upon my completing certification to sell Blue MedicareRx plans or my Agency completing the applicable Medicare Amendment as part of the certification requirements to sell Blue MedicareRx plans for Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas. Consistent with CMS Marketing guidelines, if I was previously certified and receiving renewal compensation from my Agency, and I choose to participate in the Blue MedicareRx Referral Program, and thereby elect to discontinue my certification to sell Blue MedicareRx, any future renewal compensation from sales effective January 1, 2009 or later will be forfeited. I will comply with the HIPAA Business Associate provisions in my Agency’s HCSC Producer Agreement that is applicable to any Protected Health Information (PHI) or Sensitive Personal Information (SPI) handled under this program. Prospect Eligibility Terms I understand that eligibility for referral under the Blue MedicareRx Referral Program is an individual who Is eligible to enroll during an Annual Enrollment Period, Special Enrollment Period, or an Initial Enrollment Period. Lives, or will be living, in the Blue MedicareRx service area on the effective date of coverage. Is a “new” client for Blue MedicareRx, defined as someone who is not an active Blue MedicareRx member. Additionally, the referral has not previously contacted Blue MedicareRx by phone to request information or an enrollment kit. Has accepted a Blue Referral Card** personalized with • the dedicated 800# • my agency name • my agency assigned number, and Follows required process to obtain information and enroll in Blue MedicareRx. ** A packet will be mailed to your agency shortly containing Blue MedicareRx Producer Referral Program Materials and a supply of personalized referral cards. This packet will serve as our acknowledgement of your participation. Attestation I understand that a referral expressing interest in a Blue MedicareRx plan has choices and that not all referrals provided will result in a...
I understand. 1. If I am required to provide proof of health insurance, the information submitted about the plan becomes part of my student record. Falsification of a student record is a violation of the Student Code of Conduct and could be grounds for dismissal.
I understand. This agreement applies to the use of Ark ICT systems regardless of location. There is a presumption that emails, voice messages and data are stored on Ark equipment for business purposes. This information will be filtered and monitored, and may be accessed to meet business needs. I will not: Do anything that may compromise the safety of children or staff. Disclose my username or password to anyone else. Try to use any other person’s username and password for any purpose. Do anything offensive that might bring the school or the Ark into disrepute. Access, copy, remove or alter any other user’s files without their explicit permission. Engage in any on-line activity that may compromise my professional responsibilities. Attempt to install programmes on a machine, or store programs on equipment unless approved by school or Ark management. Try to circumvent security settings or content filters. Deliberately breach anyone’s copyright.
I understand. I am responsible for complying with the CHI Acceptable Use Policy. If I have any questions about my use of CHI IT Assets I am to ask my immediate supervisor and/or the IT Help Desk for assistance. The Acceptable Use Policy is available on Inside CHI or from my manager. I understand and agree I understand that CHI maintains ownership of CHI IT Assets and the CHI Information contained on these IT Assets. CHI Information includes information that I may create, access, or obtain on behalf of CHI. I understand I am not permitted to install or remove any software on CHI IT Assets. If I need specific software for specific job duties, I will request services from IT Help Desk to install or remove such software. I agree I am responsible for complying with software licensing, copyright, and patent requirements, and the laws which protect these rights. I understand that I am not permitted to download, reconfigure, or reverse engineer any software that CHI uses with its IT Assets. I agree I am responsible for handling CHI Information in such a manner as to prevent unauthorized use or disclosure of CHI Information. I am also responsible for preventing unauthorized access and use of CHI IT Assets reasonably within my scope of influence, including, but not limited to, taking additional physical precautions to protect IT Assets such as logging out of my computer when not in use, and physical protection of IT Assets to prevent theft or loss, such as with mobile devices and laptop computers. I understand and agree I am responsible for securing CHI Information when it is used and disclosed electronically, such as using encryption when sending confidential information. I understand and agree I am responsible for knowing and following the CHI defined acceptable uses of the Internet, email, Instant Messaging, file transfer, and proper data storage as set forth in the CHI Acceptable Use policy. I understand and agree I am responsible for protecting CHI IT Assets, including my company computer, from viruses and the introduction of malware. If I have any questions or concerns about unknown emails or Internet web sites, I will contact the ITS Help Desk for assistance. I understand and agree I am responsible for securely protecting any mobile device(s) I use to access CHI Exchange/Outlook (email, calendars and contacts) or other CHI systems or applications and the information stored on such a mobile device in accordance with ITS Security Standard ITS13-S8 Mobile Device Security. Thi...
I understand. That the conversations, documents, and discussions are without prejudice and cannot be used in Court, and that the mediator will not be a part of any legal proceedings regarding what was shared in the mediation • That I understand the risks/benefits of this procedure • That the fees are paid as per our agreement and receipts can be provided • That the fees in addition are for disbursements (phone calls, emails, consultations, reading emails – billed at .1 of the hour to begin plus time taken for the action) • That the role of the clinical social worker is a mediator • That all legal reasons to inform others regarding harm to self, or children will be in compliance as per any Act or authority • That missed appointments without 48 hour notice may be billed • That I have the opportunity at any time to seek legal counsel, and am encouraged to do so • That I am here voluntarily and may withdraw, with notice to the other or the Court, at any time • That my files are kept for 10 years, that after each session I am able to receive a copy of the mediation notes • That retrieval of documentation may encumber fees No document or information shall leave this office without full payment of said account. In the event preparation of documents need to be directed to legal counsel, that payment must be paid in full before its transmission, which can occur by way of cash, cheque or Master Card/Visa. The particulars of the credit card are as follows: By way of signature I/WE provide consent to use the credit card as listed below. Credit Card Information Name: Number: Expiry date: Signature: Credit Card Information Name: Number: Expiry date: Signature: PAYMENT PLAN: ___ 50/50 Sharing plan ___One party pays for the Service ___Proportionate to Income ___Other DATE OF CONTRACT This contract shall become effective on ____________________________________ ______________________________________ Name (Parent) print and sign Name (Parent) print and sign Dr. Xxxxx Yasenik (Mediator)
I understand. If I do not do all of the things listed in Part 2, [OPIOID PRESCRIBER]: will no longer order pain medicine for me. m ay stop giving me medical care. may send me to drug abuse treatment. I know… [OPIOID PRESCRIBER] and my pharmacy may work with the police to look at any misuse or sale of my pain medicine. I f I drive while taking pain medicine, I can be charged with driving under the influence (DUI). If I am charged with DUI while taking pain medicine, [OPIOID PRESCRIBER] is not to blame.
I understand. I will look at and use only the confidential information I need to perform my job duties such as to provide health care for a patient, resident, member or other individuals, or to perform CHI business related job duties. I understand and agree I will not look at confidential information that I do not need to perform my job, for my own personal benefit or profit, for the personal benefit or profit of others, or to satisfy personal curiosity, or to disclose or divulge confidential information to others. I understand and agree I will not share confidential information with anyone who is not authorized by CHI to have access to it. If my responsibilities include disclosing confidential information with outside parties such as healthcare providers, contractors, consultants, or insurance companies, I will follow CHI policies and procedures for these types of disclosures. I agree I will take reasonable precautions and follow CHI policies and procedures for safeguarding confidential information to prevent the unauthorized use or disclosure of confidential information. I agree I will ensure that confidential information that I no longer need will be returned and maintained in the appropriate CHI department or location, or in accordance with CHI policies and procedures. I agree I understand that passwords, verification codes, or electronic signature codes assigned to me are the equivalent to my personal signature; and I will only use my password, verification or electronic signature code, in accordance with CHI policies and procedures; I will not use the password, verification or electronic signature code of other CHI employees or individuals authorized by CHI to have such password, verification or electronic signature code; I am responsible and accountable for all entries made and retrievals accessed using my password, verification or electronic signature code regardless of whether it is used by me or by another individual; and I will not use my password, verification or electronic signature code after my employment or affiliation with CHI ends.
I understand. During the course of my employment with CHI I may need to have access to information systems, applications, and information technology network infrastructure (CHI IT Assets) to obtain and use CHI information for my job duties. In order to obtain and maintain access privileges to CHI IT Assets I agree to read the following statements and conditions and indicate my intent to comply with CHI policies and procedures and this Confidentiality and Acceptable Use Agreement.
I understand. If my mobile device is lost or stolen, I will immediately report this to the CHI ITS Service Desk and I grant CHI permission to conduct a remote wipe of the mobile device. I acknowledge that the remote wipe may remove my personal information and applications on my mobile device. CHI's policy on remote wiping of CHI information contained on personal devices does not apply to an employee who has not been granted access to CHI Exchange/Outlook (email, calendars, and contacts) or other CHI IT systems or applications, or otherwise does not maintain CHI Information. I understand and agree Upon my resignation or termination of my employment or association with CHI, I grant CHI permission to deprovision my personal mobile device; or if the mobile device is owned by CHI, I will return it. I acknowledge that de-provisioning will remove and wipe all CHI Information and that my personal information that is maintained on the mobile device may be deleted, including my personal photographs, calendar, and address book. CHI's policy on remote wiping of CHI information contained on personal devices does not apply to an employee who has not been granted access to CHI Exchange/Outlook (email, calendars, and contacts) or other CHI IT systems or applications, or otherwise does not maintain CHI Information. I understand and agree I will immediately report any security incident involving CHI IT Assets to the ITS Help Desk regardless of how insignificant I may think the incident is. I agree I understand that CHI: issues user identification and secure passwords to access confidential information that is maintained electronically; regularly monitors access and use of CHI confidential information to determine my compliance with CHI policies and procedures and the terms of this Agreement; and will monitor my access, use, and transmission of information on CHI IT Assets.
