Clinical Internship Student Registration

CONFIDENTIALITY AGREEMENT

I understand that Lifepoint Health has legal and ethical responsibilities to safeguard the privacy of all patients and to protect the confidentiality of their patients’ health information. I understand I am expected to comply with hospital policies as they relate to maintaining the privacy of our patients’ individually identifiable health information..

I know it is my right and responsibility to seek guidance about privacy issues when I am uncertain about which actions to take.

I will fully cooperate in any investigation of conduct, which may be a violation of hospital policies and standards.

I also agree to the following statements:

1. I will not disclose or discuss any confidential information with others, including friends or family, who do not have a need to know it.
2. I will not in any way divulge, copy, release, sell, loan, alter, or destroy confidential information except as properly authorized.
3. I will not discuss confidential information where others can overhear the conversation. It is not acceptable to discuss confidential information even if the patient’s name is not used.
4. I will not make any unauthorized transmissions, inquiries, modifications, or purging of confidential information.
5. I agree that my obligations under this Agreement will continue after my relationship ceases with the Hospital.
6. Upon termination, I will immediately return any documents or media containing confidential information to the Hospital.
7. I understand that I have no right to any ownership interest in any information accessed or created by me during my relationship with the Hospital.
8. I will act in the best interest of the Hospital and in accordance with its Code of Conduct at all times during my relationship with the Hospital.

Dated this the 23 day of March, 2023.

Checking this box indicates that the information provided is correct and that I agree to the above information.