CONFIDENTIALITY AGREEMENT FOR EMPLOYEES
I am aware that the medical practice named below has policies and
procedures regarding the privacy, confidentiality, and security
of personal patient information and that it must comply with Saskatchewan’s
Health Information Protection Act. I understand that it is my responsibility
to be familiar with the requirements outlined in these policies
and procedures and I have read the current version of these policies
and procedures.
As an employee of the medical practice named below, I agree to
observe and comply with all policies and procedures of the medical
practice with respect to privacy, confidentiality, and security
of patient information. Except when I am legally authorized or
compelled to do so, I will not use or disclose personal patient
information that comes to my knowledge or possession by reason
of my employment with this medical practice.
I understand that any breach of the policies and procedures,
including misuse or inappropriate disclosure of patient information,
may be just cause for the termination of my employment.
Employee name: (please print) ___________________________________________________________
X______________________________________ _________________________________________
Employee Signature
Date (dd/mm/yy)
Medical practice:____________________________________________________________
Witness (privacy officer): (please print) Dr________________________________________________
X______________________________________ _________________________________________
Witness Signature
Date (dd/mm/yy)
*Click
here to print the PDF version of this form
 Back
To Sample Privacy Forms
|
