HFM Confidentiality Commitment/Student Orientation Completion

I understand that during my engagement with Holy Family Memorial, I may have access to or come in contact with confidential patient, business, or provider information. This information may be in any form (i.e. oral, written, or electronic) and any format.

I understand that all patient and business information is strictly confidential and can be shared only with those who have a “need to know” in the due course of business and operations, and only in a secure area. “Need to know” is defined as what’s necessary for one to perform one’s specific job responsibilities adequately.

I also understand that I am not allowed to access my own patient care record or those of any of my family members or friends/acquaintances without following proper release of information or record viewing procedures.

I understand that I will be subject to, and agree to abide by, the same rules, regulations, policies, procedures, and standards of Holy Family Memorial as are established for our employees in matters related to confidentiality and welfare of HFM's patients. Holy Family Memorial may, in its sole discretion, terminate my participation in clinical education at Holy Family Memorial for breach of information. I further understand that I could be subject to legal action, including but not limited to lawsuit for invasion of privacy, or unauthorized access or disclosure of confidential patient healthcare information.

I understand that I will have the status of a student and that I will not be deemed to be an employee of HFM for purposes of social security, worker's compensation, unemployment compensation, or any other purpose. I agree that HFM will not provide me any wages, monetary compensation, or other benefits during my clinical/internship.

I understand that the facility may, in its sole discretion, terminate my participation in clinical education at the facility.

Student Agreement