Policy Manual sample

MDT Home Health Care Agency, Inc. BOARD OF DIRECTORS CONFIDENTIALITY STATEMENT BOARD OF DIRECTOR MEMBER NAME: __________________________________ Title: ___________________________________________ Date: ____________ I have been formally instructed in maintaining the confidentiality of all Agency matters/issues discussed in my presence as member of the BOARD OF DIRECTOR, and the patient’s medical records and understand that the medical information regarding the patient may not be discussed with anyone, either inside or outside the agency (except as needed to conduct the business of the day). I understand that no medical records are to be removed from the home health agency unless a "Release of Information" form has been completed and signed by the patient. It is my understanding that such discussion or release of information is cause for dismissal. I have been formally instructed in the policies and procedures of the Agency, and my obligations as member of the Board of Director. I have been formally instructed in the policies and procedures of the Agency regarding full compliance with all HIPAA regulations. I will carry at all working time my Identification Card. BOARD MEMBER SIGNATURE: __________________________________ DATE: ________________ Home Health Agency Policies A-31