New Jersey Department of Health

USER CONFIDENTIALITY STATEMENT

FOR ACCESS TO THE NEW JERSEY IMMUNIZATION INFORMATION SYSTEM

The New Jersey Immunization Information System (NJIIS Registry) is a Statewide automated and electronic immunization registry and the single repository of immunization records in the State. N.J.S.A. 26:4-131 et seq. authorizes the Department of Health to operate an immunization information system and allows authorized users to exchange information electronically. The information in the NJIIS Registry is confidential personal preventive health information and other demographic information. The purposes of the NJIIS are to coordinate and promote effective and cost-efficient disease screening, prevention, and control efforts throughout the State; provide access to a registrant’s immunization and preventive health screening information to promote health maintenance; provide a mechanism to facilitate notice to registrants of an upcoming or overdue vaccination; and assist in identifying registrants that require immediate vaccination in the event of a vaccine preventable disease outbreak or other health emergency. Access to the NJIIS Registry shall be limited to authorized users who sign the user confidentiality agreement.
USER CONFIDENTIALITY AGREEMENT

I have read and understood the User Confidentiality Statement and the obligations and responsibilities listed below. I agree that:

1.	I shall keep strictly confidential all information, in any format, that I receive or have access to as an authorized user of the NJIIS Registry.

2.	I understand I am authorized access to the NJIIS Registry at the following level and agree to keep my password secure and will not permit use of my access privileges or password by any other person or entity:

General Reader Access	School/College General Reader Access

General User Access	School/College General User Access

Site Manager Access	VFC Data Entry Only

3.	I will only access the NJIIS Registry to access or submit information and to generate documentation in the official course of my duties and responsibilities.

4.	I agree that I shall strive to provide timely, accurate and complete data into the NJIIS Registry.

5.	I will not divulge, disclose, use, transfer, copy, remove, or otherwise furnish personally identifiable information or documentation obtained from the NJIIS Registry to any individual or organization for any use not authorized by the Department of Health or to any person or entity not directly involved with the conduct of my official duties as they relate to immunizations, except as permitted or authorized by NJIIS policy, State administrative code, State or federal law.

6.	I will not copy all or part of the database or software used to access the NUIIS.

7.	I understand that the Department may audit any record, electronic or written, that is part of the NUIIS Registry or pertains to the health information entered into the NJIIS Registry by an authorized user.

8.	I agree to immediately report to the NJIIS Site Administrator at this NJIIS Site and the NJIIS Help Desk any breach of confidentiality.

9.	I understand that any violation of the above provisions may result in suspension or termination of user privileges, disciplinary action, and the imposition of any and all penalties as prescribed by applicable State and Federal laws.

I have read and understood the User Confidentiality Statement for Access to the New Jersey Immunization Information System and the User Confidentiality Agreement. I agree to abide by the User Confidentiality Agreement. I understand the consequences to me if I disclose confidential information without necessary authorization.

User Name (Print):
User Signature:
Date:
As a registered NJIIS site, I will ensure that my employees/agents/assignees granted access privileges adhere to the confidentiality provisions of the NJIIS in the performance of their official duties. I will promptly notify the NJIIS Help Desk to deactivate their access privileges when an authorized user departs my practice/organization in order to maintain system security.

I acknowledge that as an NJIIS site, this site is subject to review of immunization documentation by the Department’s Vaccine Preventable Disease Program or its designated agent.

Administrator Name (Print):
Administrator Signature:
Date:

IMM-43

JUL 12

IMM-43, User Confidentiality Agreement for Access to NJIIS, User Confidentiality Agreement

IMM-43, immunization, user confidentiality statement, NJIIS, user confidentiality agreement, VPDP, vaccine preventable disease program, IMM

ewhite

2007-08-01

NJDOH