36C24918R0399-002.docx

INFORMATION PROTECTION

NON-DISCLOSURE AGREEMENT

Contract Number:

Appropriate background screening is required prior to gaining access to any Government information under this contract and disclosure of any such information encountered during the conduct of this work is strictly prohibited.

But for medical emergencies (42 C.F.R. §2.51), I agree to keep confidential or as the Department of Veterans Affairs (VA) may otherwise consent in writing, not to disclose, or make use of except for the benefit of the VA, at any time either during or subsequent to my performance under this contract, any confidential information, knowledge, data or other information of the VA relating to patient health information or other subject matter pertaining to any business of the VA. This agreement also pertains to any deliverable which I may produce, obtain, or otherwise acquire during the course of my performance under this contract. I further agree not to deliver, reproduce or in any way allow any such confidential information, knowledge, data, or other information or any documentation relating thereto, to be delivered to or used by any third parties, without specific direction or consent of a duly authorized representative of the VA. My obligation to maintain VA proprietary and otherwise confidential information, knowledge, and data in confidence shall only be relieved by written consent from the VA.

Furthermore, at the conclusion of the contract or in the event of termination of my employment with the contractor, I will not take with me any confidential information knowledge, data or other information, or any documentation, which I may produce or obtain during the course of my performance under this contract.

I understand that the requirement of FAR 24.1, Protection of Individual Privacy, the Privacy Act (5 U.S.C. 552a), Confidentiality of Certain Medical Records (38 U.S.C. 733), Confidentiality of Medical Quality-Assurance Records (38 U.S.C. 5705), Confidential Nature of Claims (38 U.S.C. 5701), and Public Law 104-191, C.F.R. Parts 45, 160, 162, and 164 (Health Insurance Portability and Accountability Act) apply to the services that my employer/firm will be providing and that violations may involve the imposition of criminal penalties. I also understand that any violation of this agreement may result in penalties up to and including termination of my employer’s current contractual relationship with the VA, as well as my and/or my employer’s prohibition from engaging in future contractual relationships with the VA.

By my signature below, I acknowledge receipt of the Non-Disclosure notification an agree to handle all government information in a sensitive manner so that no violation or impropriety shall result.

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