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This Confidentiality/HIPAA Agreement between Restoration Family Services, Inc. (RFS) (hereinafter “Company”) and,
(hereinafter “Employee”) is effective as of
All personnel who accept assignments with Restoration Family Services, Inc. (RFS), share the responsibility of observing a strict code of ethics and confidentiality. In the process of performing our work, it is possible to overhear many items regarding confidential information. These are not to be discussed outside the facility. No information, records or materials concerning the people we serve or the facility’s business may be used, released, or discussed with anyone outside the facility or with any other employee(s). There will be disciplinary action and possible civil penalties taken upon any staff member that improperly release or disclose confidential information. In the course of performing job duties for the Covered Entity, the Employee may have access to consumer protected health information. All consumer health information is CONFIDENTIAL and is to remain confidential. Employee will limit his/her exposure to consumer health information to the minimum necessary needed to accomplish required tasks. Use or disclosure of protected health information by the Employee to any other individual or entity is grounds for dismissal and/or legal prosecution. Employee herein agrees to not use or disclose any consumer protected health information to which they may have access, to any other individual or entity, not required by his/her job duties. This agreement remains in effect throughout the Employee’s employment with the Covered Entity (RFS), as well as after employment is terminated with the Covered Entity (RFS). I have read, understand, and agree to comply with the Confidentiality/ Hippa Agreement. I further understand that breach of confidentiality may result in disciplinary action, possible dismissal, and legal penalties including fines. My signature acknowledges that I have read, had training, and understand the policy on Confidentiality and HIPAA.
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