DJJ Form AD-FS1415C Attachment C "Acknowledgement of Receipt of Myfloridamarketplace Confidentiality Policy" - Florida

What Is DJJ Form AD-FS1415C Attachment C?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 15, 2007;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DJJ Form AD-FS1415C Attachment C by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download DJJ Form AD-FS1415C Attachment C "Acknowledgement of Receipt of Myfloridamarketplace Confidentiality Policy" - Florida

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AD-FS 1415C
New 5/15/07
DEPARTMENT OF JUVENILE JUSTICE
MyFloridaMarketPlace Confidentiality Policy
PLEASE PRINT: _________________________, __________________________, _________________
LAST NAME
FIRST NAME
People First ID #
1.
I have read and understand the Confidential Information-MFMP policy, FDJJ 1415 regarding the
rules limiting confidential information being input and attached to MFMP transactions.
2.
I understand that if I discover any confidential information in the MFMP system that I should
immediately report it to the agency MFMP Privacy Officer.
3.
I understand that any questions or concerns I have regarding this confidentiality policy should
be directed to either the agency HIPAA Compliance Office, the MFMP Privacy Officer or the
General Counsels Office.
ACKNOWLEDGMENT
________________________________________________
___________________________________
EMPLOYEES SIGNATURE
TITLE
__Career Service
__SMS or SES
__OPS
Original:
Official Personnel File
Copy:
Employee
Save As
Reset/Clear Form
Print Form
MFMP Confidentiality Policy Acknowledgment Form
Attachment C
AD-FS 1415C
New 5/15/07
DEPARTMENT OF JUVENILE JUSTICE
MyFloridaMarketPlace Confidentiality Policy
PLEASE PRINT: _________________________, __________________________, _________________
LAST NAME
FIRST NAME
People First ID #
1.
I have read and understand the Confidential Information-MFMP policy, FDJJ 1415 regarding the
rules limiting confidential information being input and attached to MFMP transactions.
2.
I understand that if I discover any confidential information in the MFMP system that I should
immediately report it to the agency MFMP Privacy Officer.
3.
I understand that any questions or concerns I have regarding this confidentiality policy should
be directed to either the agency HIPAA Compliance Office, the MFMP Privacy Officer or the
General Counsels Office.
ACKNOWLEDGMENT
________________________________________________
___________________________________
EMPLOYEES SIGNATURE
TITLE
__Career Service
__SMS or SES
__OPS
Original:
Official Personnel File
Copy:
Employee
Save As
Reset/Clear Form
Print Form
MFMP Confidentiality Policy Acknowledgment Form
Attachment C