I, of have a legal and ethical responsibility to protect the privacy of individuals and families referred (“consumer”) to protect the confidentiality of their health information.
By signing this document, I understand and agree to the following:
1. “Confidential Information” means any and all non-public, medical, financial and personal information in whatever form (written, oral, visual or electronic) held or received. Confidential Information shall include all information which (i) has been labeled in writing as confidential, (ii) is identified at the time of disclosure as confidential, (iii) is commonly regarded as confidential in the health care industry, or (iv) is Protected Health Information as defined by HIPAA.
2. I agree to obey all applicable laws and regulations, including HIPAA and the HITECH Act, to the extent applicable, in meeting their obligations under this Agreement.
3. I agree to only use or disclose the minimum necessary information needed (as required by the HIPAA Privacy and Security Rule 164.502, 164.514d).
4. I agree not to share or discuss any consumer health or other confidential information with others, including friends or family, who do not have a need-to-know. I understand that consumer information includes, but is not limited to, the medical records of my family, friends, co-workers, and myself.
5. I shall not disclose to unauthorized personnel, inside or outside the organization whether or not an individual is a patient.
6. I agree not to discuss any consumer health or other confidential information where others can overhear the conversation, e.g. in hallways, on elevators, in the cafeteria, on shuttle buses, on public transportation, at restaurants, or at social events. It is not acceptable to discuss clinical information in public areas, even if a consumer’s name is not used.
7. I understand when utilizing or interacting with others regarding consumer health or other confidential information, this must be limited to authorized personnel.
8. I will not use, disclose, or in any way reveal or disseminate to unauthorized parties any information I gain through contact with materials or documents.
9. I will not disclose or in any way reveal or disseminate any information pertaining to the consumer that comes to my attention
10. No waiver of any provision of this Agreement, including this paragraph, shall be effective unless the waiver is in writing and signed by the party making the waiver.11. I have read and agree to comply with the Policy and Procedures.
My signature below indicates I have read this agreement, understand its terms, and I agree to abide by this agreement.