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independent-healthcare-professional-confidentiality-agreement

As a health care professional who treats patients and residents of facilities (hereafter referred to as
“Health Care Professional”), you may have access to “confidential information.” The purpose of this
the agreement is to confirm your understanding of and obtain your commitment to your duties regarding
confidential information.
Confidential information is valuable, sensitive, and protected by law and facility policies. As a Health
Care Professional, you must conduct yourself in strict conformance to applicable laws and the facility
policies and to abide by the duties described below governing confidential information.
You will be responsible for any alteration, destruction, misuse, or wrongful disclosure of confidential
medical information by you and for any failure by you to safeguard any authorization codes to access
confidential information. You understand that your failure to comply with the duties described below and
this agreement may also result in loss of privileges to access confidential information, loss of privileges to
treat patients and residents at facilities and to legal liability.
As a Health Care Professional, you understand that you will have access to such confidential medical
information that may include, but is not limited to, information relating to:
Patients and residents (such as medical records, private conversations, admittance information, resident
financial information, etc.)
• Other contractors (such as salaries, employment records, disciplinary actions, etc.)
• Facility information (such as financial and statistical records, strategic plans, internal reports,
memos, contracts, peer review information, communications, proprietary computer programs,
source code, proprietary technology, etc.)
• Third party information (such as computer software programs, client and vendor proprietary
information, proprietary technology, etc.).
As a condition of and in consideration of your access to such confidential information, you promise that:
1. You will use confidential information only as needed to perform your legitimate duties at
facilities.
a. You will only access confidential information needed to treat your patients and residents
or fulfill your responsibilities.
b. You will not in any way divulge, copy, release, sell, loan, review, alter, or destroy any
confidential information except as properly authorized within the scope of your
professional activities as a Health Care Professional and treater of residents affiliated
with facilities.
c. You will not misuse or fail to safeguard confidential information.
2. You will safeguard and will not disclose any authorization codes or keys you have that allow you
to access confidential information. You accept responsibility for all activities undertaken using
your authorization codes or keys.
3. You will report to the Facility Privacy Officer activities by any individual or entity you suspect
may compromise the confidentiality of confidential information described in this agreement.
4. You understand that your obligations under this agreement will continue after the termination of your
privileges or permission to treat patients and residents of facilities. You understand that facilities
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may review, revise or terminate your privileges to access and use confidential information as
reasonably warranted to protect the confidentiality of such information.
5. You understand that you have no right to an ownership interest in any confidential information
referred to in this agreement. The facility may at any time revoke your key, access code, other
authorization, or access to confidential information.
6. Health Care Professional shall indemnify and hold facilities harmless from and against all claims,
liabilities, judgments, fines, assessments, penalties, awards, or other expenses, of any kind or
nature whatsoever. This indemnification includes without limitation, attorneys’ fees, expert
witness fees, and costs of investigation, litigation, or dispute resolution, relating to or arising out
of any breach or alleged breach of this agreement by Health Care Professional.
7. You will respect the ownership of proprietary software.
8. You will not operate any non-licensed software on any computer provided by any facility.
By signing this, I agree that I have read, understand, and will comply with this agreement.