University of Iowa Mobile Clinic Confidentiality Agreement
As a member of the Mobile Clinic patient care team, you will have access to patient medical records and/or computer-stored information. This information may not be discussed with anyone unless disclosure is required to perform your duties and responsibilities. It is a breach of confidentiality to review patient information not required in the performance of your duties. You are responsible for maintaining your patient’s confidentiality by sharing patient information only with others who need to know and by handling any documentation of information appropriately. These expectations are in order to ensure volunteer compliance with professional ethical standards of confidentiality as well as legal confidentiality standards outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
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I declare that I have read and that I understand the Mobile Clinic’s policy concerning patient confidentiality set forth above. Furthermore, I understand that the allegation of violation of the patient confidentiality policy is reason for review by the Mobile Clinic, and, if the allegation is found to be true, may result in dismissal from the Mobile Clinic *
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