Security Confirmation for Employees Who Do Not Require Database Access


  1. Complete the following steps to submit security and confidentiality requirements:
  2. Complete the Security and Confidentiality Training course.
  3. For those who take the online security and confidentiality course:
  4. Complete the training and pass with a score of at least 85 percent.
  5. Save the completed course certificate as Lastname_Firstname_Agency_Strn.pdf.


*All staff who work with PHI are required to take Data Security and Confidentiality training upon hire, and annually thereafter

User information

*Note: New access requests and renewals must be filled out by the employee/contractor.

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Who is your manager/supervisor? (First Name and Last name)

Please provide an email address.

Is the (LRP)Local Responsible Party the same as Manager/Supervisor?*

Please check the box if the LRP is the same as the Manager/Supervisor

TB/HIV/STD Confidentiality E-Agreement

Please refer to PDF form link on the DSHS website to read the full agreement.


Confidentiality Agreement for reference only (DO NOT UPLOAD)

TB/HIV/STD Data Security and Confidentiality Certificate

*Please upload your TB/HIV/STD Data Security and Confidentiality Certificate

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