A medical confidentiality contract is a legitimate understanding between a physician/ doctor or a medical specialist and a patient in order to secure the medical record information & data of the patient. This contract includes types of the medical data, patient information and confidentiality condition.

Sample Medical Confidentiality Contract:

Contract number: 45/ MCA

Date: February 13th, 2011

This medical confidentiality contract is made & entered between Dr. Jack Hue, Address: Hue Health Clinic, Building No: 9, Brown Arcade, Spencer Street, New York, America, hereinafter referred as the doctor.


Ms. Samantha Paterson, Address: House No: 8, Bakers Road, Salt lake City, New York, America, hereinafter referred as the patient.

Whereas, the patient and the doctor are ready to commence this contract and are agreed to the mentioned term & conditions. Both the parties have understood the importance of this legitimate confidential document.

This contact is validating from February 14th, 2011

Term & Conditions:

Duties & Responsibilities:

The doctor will perform the required medical test of the patient and maintain all essential records. The patient will cooperate during the medical procedures and the treatment.

Confidentiality clause:

The doctor has to keep the medical records, case history, test reports and fitness data secret. The doctor will not share or provide this above mentioned information of the patient to any third party.


Any violation to the above mentioned consideration & confidentiality cause can cause the termination of this contract.

Acceptance of the Medical Confidentiality contract:

Signed by the Doctor:                                                                   Singed by the Patient:

Dr.Jack Hue                                                                                            Samantha Paterson

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