Substance Abuse Policy & HIPAA Inservice Receipt and Acknowledgement of Substance Abuse Policy & HIPAA Inservice <strong>Receipt and Acknowledgement of Substance Abuse Policy & HIPAA Inservice</strong> I hereby acknowledge that I have received and read the Substance Abuse Policy and that I accept the provision set forth therein. I understand that under the Policy, I am prohibited from: manufacturing, using, possessing, selling, distributing, dispensing, or transporting illegal drugs or alcohol while I am on Company premises or during work hours, including breaks and meal periods; and from reporting to, or being at, work while under the influence of illegal drugs or alcohol. I also understand that if I engage in any such conduct, I will be subject to disciplinary action, up to and including immediate discharge or I may be required to successfully complete a rehabilitation program as a condition of continued employment. I further understand that I am required, at COMPANY’s request, to submit to urinalysis and/ or blood test to detect the presence of illegal drugs or alcohol in the system and that a confirmed positive test result, or a refusal on my part to be tested, or any questionable results during the testing process may result in my immediate discharge. I hereby certify that I have attended the HIPAA In-service, read material and I understand the information presented. I acknowledge that I have an obligation to perform my duties in a lawful manner and consistent with the standards of business conduct. I further understand that it is my duty to report violation of the law or standards of business conduct to my supervisor, a member of the corporate compliance committee or through the care line. I have reviewed the training session presented by HSE Staffing Agency LLC on the Privacy and Security requirements of HIPAA. I understand that I must fully comply with these requirements in order to maintain access to protected health information at all my work locations. Name * Name First First Last Last Signature * Clear Date * If you are human, leave this field blank. Submit
