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

Form AD-FS1415C or the "Attachment C - Acknowledgement Of Receipt Of Myfloridamarketplace Confidentiality Policy" is a form issued by the Florida Department of Juvenile Justice.

The form was last revised in May 15, 2007 and is available for digital filing. Download an up-to-date Form AD-FS1415C in PDF-format down below or look it up on the Florida Department of Juvenile Justice Forms website.

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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
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