A healthcare confidentiality contract is one that is entered into by a healthcare unit with a patient. The contract has clauses that help to protect the confidentiality of the medical history of patients. It is mandatory for health care unit to maintain secrecy of medical information of the patient according to the confidentiality of medical information act pertaining to each state.

Sample Health Care Confidentiality Contract

This contract is entered between the healthcare unit including nursing, healthcare unit staff, housekeeping staff and all other medical volunteers and the patient on 25th march 2013 where in the healthcare unit agrees for the following:

I agreed to abide by the following clauses:-

  • I will maintain the confidentiality of all the patient records and any other information that involves medical management of the patient.
  • I shall not disclose patient information in any manner that causes any harm to the patient or the relatives of the patient in any manner.
  • I shall keep all medical history records which include papers, photos, images, videos, pathology reports and diagnostic reports of the patient in a confidential manner.
  • I shall ensure to keep computerized and electronic information of the patient confidential.
  • I shall maintain confidentiality with regard to the verbal discussion and observation about the patient.
  • I shall withhold all personal information of the patient such as social security number, telephone number, mailing address, spouse details, social security number, health insurance number etc.
  • I understand that unauthorized release of patient information to those who need not know it will make me liable for legal prosecution and disciplinary action by my employer as well.

I acknowledge to have read and understood all the clauses specified above and signify my compliance to all the clauses specified herein above. In the event of violation of any of the clauses specified above the patient has the right to take appropriate action against me.

Date:  ______________________

Signature: __________________

Name: _____________________

Department: ________________

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