Confidentiality Statement for Observers/Students

The federal Health Insurance Portability and Accountability Act (HIPAA), and its regulations protect the confidentiality of medical, educational, and personal information of patients. Such information may not be disclosed except as authorized by law or as authorized by the patient's parent/legal guardian. These privacy laws and regulations apply to all persons, including all persons conducting observations in clinical settings. All observers are required to agree to and sign this confidentiality statement. I understand that, as an observer, I may see, hear, or be exposed to confidential information about patients, such as medical information, information about a patient’s disability, educational performance, and services received, or other related information about a patient. 

 

I acknowledge that it is my responsibility to respect the privacy and confidentiality of this information. I will not access, use, or disclose any confidential information outside of my observation of patients.

 

I understand that if I breach any provision of this Agreement, I may be subject to civil or criminal liability.