Volunteer Confidentiality HIPAA Agreement

FAITHFUL PAWS PET THERAPY
SPONSORED BY BELLAIRE UNITED METHODIST CHURCH

HIPAA – It’s the LAW. HIPAA mandated regulations that govern privacy, security, photographic and electronic transaction standards of patient information.

  1. Confidentiality of Patient Information. As a Faithful Paws volunteer. I understand and acknowledge that: (1) services provided to patients are private and confidential; (2) to enable such services to be performed, patients provide personal information with the expectation that it will be kept confidential and used only by authorized persons as necessary; (3) all personally identifiable information provided by patients or regarding medical services provided to patients, in whatever form such information may exist, including oral, written, printed, photographic and electronic formats (collectively, the Confidential Information”) is strictly confidential and is protected by federal and state laws and regulations that prohibit its unauthorized use or disclosure; and (4) in the course of my volunteer activities with Faithful Paws Pet Therapy, I may see or learn of Confidential Information.
  2. Disclosure, Use and Access. I agree that, except as authorized in connection with my volunteer assignment, I will not at any time use, access or disclose any Confidential Information to any person (including but not limited to other volunteers, friends and family members). I understand that this obligation remains in full force during the entire period of my volunteer activities and continues in effect after my volunteer activities.
  3. Confidentiality Policies. I agree that, even though I am a volunteer, I must and will comply with the same confidentiality policies that apply to all staff in the hospitals and or facilities.
  4. Return of Confidential Information. At the end of my volunteer work, or at any other time upon request, I agree to promptly return to Faithful Paws Pet Therapy all copies of any Confidential Information then in my possession or control (including all printed and electronic copies).
  5. Term Certification. I understand that the term of this authorization shall commence on the date hereof and be without limitation.
  6. Requirement. I understand that my agreement to abide by the confidentiality policies, and this Agreement, is a condition of my volunteer activities with Faithful Paws Pet Therapy. I understand that failure to comply with confidentiality policies will result in my no longer being accepted for volunteer activities.
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