Street Address *
Phone Number *
Organization and Profession
Name of Organization *
Student Nurse Educator Pharmacist Social Services EMS/First Responder Other
Preferred Target Audience (select all that apply) *
Preschool K-5th 6th-8th 9th-12th College Caregivers/Adults Other
Main reason for taking this course *
Work Requirement Personal Interest Other
<18 18-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99
Information Protection Agreement
The purpose of this agreement is to protect the Poison Control System Prevention Training Program (PPTP) electronic information from accidental or intentional disclosure or modification. This agreement is intended to serve as a general information protection overview, and may be supplemented by other specific policies required by law such as the Health Insurance Portability and Accountability Act (HIPAA). This agreement applies to all users of the program who must uphold their responsibility for the protection and appropriate use of the Poison Center information. Within the context of this policy, information refers to all information that is electronically processed, stored, used or transmitted. Information resources include, but are not limited to: software, computer applications and e-mail. Compliance with this policy is mandatory. Each user must understand his/her role and responsibilities regarding information security issues, and protecting the Poison Center information. Any non-compliance with this or any other security policy that results in the compromise of the Poison Center information integrity may result in possible prosecution under applicable legislation. I agree to maintain and protect the Poison Center information from any unauthorized alterations (add/change/delete). Furthermore, I agree to protect and maintain the Poison Center information that is electronically processed, stored, used or transmitted to or by me from any intentional and unintentional violation.
The information contained in this training is designed to be informational and educational. Under no circumstances is this training to replace the expert advice of a qualified health care professional. In the event of a poison emergency, contact the California Poison Control System immediately. The California Poison Control System, its employees and affiliates assume no responsibility in the usage of the information provided in this training.