STUDENT EXTERNSHIP/OBSERVATION CONFIDENTIALITY AGREEMENT
I will keep all patient information confidential. I will disclose patient information in accordance with the policies of the facility that I am assigned to during my student externship experience. Furthermore, I understand and agree to comply with the guidelines set forth by HIPAA.
I will not discuss any information, patient-related or relating to the operations of the facility to include my own health record if applicable. I will keep all security codes and passwords used to access the facility, equipment and computer systems confidential.
I will access or view patient information only as it is required in the scope of my student experience to include my own health record if applicable.
I will not disclose, copy, transmit, modify or destroy patient information or other confidential practice information without the permission of my supervisor or the practice’s privacy officer.
I agree to comply with these conditions even after my student externship experience is terminated.
I understand violation of this agreement may result in disciplinary action, up to and including termination from the externship and dismissal from my program. My signature on this agreement indicates that I, a student of MedCertify have read, understand and will comply with all aspects of this confidentiality agreement.