File GBO-E

As a volunteer, as a trustee, as an employee (please underline one) of the Portage la Prairie School Division, I acknowledge and understand that I may/will have access to personal health information (statutory definition below) about others, including students, the confidentiality and protection of which is governed by The Personal Health Information Act.

I further acknowledge and understand that the School Division has established written policies and procedures containing provisions for security of personal health information in the Division’s possession during its collection, use, disclosure, storage and destruction; provisions for the recording of security breaches; and corrective procedures to address security breaches.

I further acknowledge that I have been provided orientation and that I have received or will receive ongoing training about these policies and procedures.

I acknowledge that I am bound by the policies and procedures established by the School Division in accordance with the Act and I am aware that a consequence of breaching them is prosecution under the Act, and/or disciplinary action.

Signature: ___________________________________ Date signed: __________________

Print name: __________________________________ Date signed: __________________

"personal health information" means recorded information about an identifiable individual that relates to:

1. the individual’s health, or health care history, including genetic information about the individual;
2. the provisions of health care to the individual;
3. payment for health care provided to the individual and includes;
4. the PHIN and any other identifying number, symbol or particular assigned to an individual;
5. any identifying information about the individual that is collected in the course of, and is incidental to, the provision of health care or payment for health care.

"health care" means any care, service or procedure:

1. provided to diagnose, treat or maintain an individual’s physical or mental condition;
2. provided to prevent disease or injury or promote health;
3. that affects that structure or a function of the body;

and includes the sale or dispensing of a drug, device, equipment or other item pursuant to a prescription.