Non-Disclosure Agreement
This Agreement relates to your responsibilities regarding access or exposure to confidential
information in the Department of Human Services and the Oregon Health Authority.
This document is to clarify my role related to the Department of Human Services (DHS) and
Oregon Health Authority (OHA) confidential information and computer and network systems.
I understand that I may have access to or be exposed to certain sensitive and confidential client
or business information, and that I am required to protect such confidential, sensitive and
personal information.
By signing below I am certifying my understanding and acknowledgment that my relationship
with DHS or OHA requires unconditional adherence to the following mandatory conditions.
1. I understand that I must maintain the confidence of any paper or electronic document or
file containing confidential information involving the state’s computer and network
information and any confidential information stored on or transported by those systems.
2. I understand that I must maintain the confidence of any verbal information, which I may
hear or overhear, containing confidential information involving the state’s computer
and network information and any confidential information stored on or transported by
those systems.
3. I will not allow anyone to use my position or knowledge to conduct tests or to log in to
any electronic system containing confidential information.
4. I will not use my special access to create, copy or disclose confidential information for
my or anyone else’s personal use or benefit.
5. I will only use hardware and software tools that are provided by DHS or OHA so
that I will not compromise the security of the state’s computer and network system
or information.
6. I understand that “confidential information” means any matter related to:
 Passwords and accounts (e.g., personal passwords and special access accounts);
 Computer and network information that is sensitive;
 Reports, findings and other information related computer and network information
generated for the state;
 Reports, findings and other information related to DHS or OHA clients,
participants or personnel.
 Anything else a reasonable person would consider to be confidential
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7. I understand that “maintain the confidence” means that, unless clearly
required by my role, I am prohibited from divulging or confirming such confidential
information to any person, employee or third party unless authorized.
8. I understand and accept the responsibility to report known confidentiality violations to
the Oregon Health Authority Information Security and Privacy Office at 503-945-6812 or
dhsinfo.security@state.or.us
9. Violation of confidentiality obligations may result in my removal from the DHS or OHA
premises, disqualification from being on DHS or OHA property in the future, potential
costs associated with DHS or OHA action undertaken to remedy the violation or such
other DHS or OHA action commensurate with the nature and gravity of the violation.
By signing this agreement, the undersigned acknowledges that he or she has read, understands,
and agrees to comply with the above principles governing the use of the Department of Human
Services and the Oregon Health Authority confidential information assets.
Signature:
Date:
Printed name:
Parent/guardian signature:
Department/authority/section/unit:
Department/authority manager/supervisor:
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