10+ Patient Confidentiality Agreement Templates – Free Sample, Example Format Download

In hospitals and medical clinics, it is a norm to collect the details of a patient and record these in a file. Later, the other reports and medical details are added to this file. The employees who take down these details and the ones who handle and manage these files are privy to most of the patients’ details. You can also see License Agreement Templates.

Any disclosure of these is considered to be unprofessional on the part of the medical facility. Thus, all the employees in a hospital or clinic are expected to sign a patient confidentiality agreement to ensure that they do not reveal any of the patient’s information without prior consent from the person concerned.

Sample Oncology Patient Confidentiality Agreement

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With cancer cases being on the rise, patients meet their oncologists for treatment and share all their history with the doctor. The employees who work with the doctor are most often privy to these secrets. They are thus expected to sign an Oncology Patient Confidentiality Agreement to swear them to secrecy.

Example Obstetrics Patient Confidentiality Agreement Form

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Many a times, patients meet their obstetrician for abortions and other problems which they do not wished to be revealed. In such cases the doctor and the employees of the clinic or hospital need to sign an Obstetrics Patient Confidentiality Agreement to ensure that they do not disclose any of their patients’ secrets or ailments

Surgery Patient Confidentiality Agreement Sample

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In order to undergo a surgery, a patient and his relatives are required to share a lot of personal information like family history, financial details etc. Revealing these to an outside source can be catastrophic for the image of the hospital and the surgeon concerned. The employees who work at close quarters with the surgeon are thus required to sign a Surgery Patient Confidentiality Agreement which assures the patients that their secrets and personal details are in safe hands.

Psychiatric Patient Confidentiality Agreement Example

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Most psychiatric treatments are undergone by the patients in complete secrecy. Also, revealing the details of the person’s problems is considered unethical in psychiatry which is why the doctor and his staff members are required to sign a Psychiatric Patient Confidentiality Agreement to ensure that the patients’ secrets will be safeguarded. You can also see Agreement Templates.

Example Generic Patient Confidentiality Agreement

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This is a standard design of a patient confidentiality agreement which can be easily customized according to the needs and requirements of the parties concerned. This agreement outlines all the important aspects and segments that should be present in a patient confidentiality agreement.

Patient Psychotherapist Confidentiality Agreement Sample

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Sample Patient Information Confidentiality Agreement

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Size: 14.9 KB

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Doctor Patient Confidentiality Agreement Sample

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Size: 1.9 MB

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Example Adolescent Patient Confidentiality Agreement

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Size: 222.4 KB

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Gynecologists Patient Confidentiality Agreement Sample

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Size: 35.2 KB

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Uses of Patient Confidentiality Agreement

  • In hospitals to ensure that patient details and their ailments remain a secret from outside sources
  • In clinics to safeguard patient details from outsiders
  • In psychiatric wards to maintain secrecy of the problem and treatment of the patients
  • In obstetric clinics to ensure the privacy of the patients who do not wish to reveal their details or the purpose of their visit to anyone else other than the doctor

Benefits of Using Patient Confidentiality Agreement

  • The agreement can be drafted according to the preference of the patient or the medical authority concerned
  • It serves as a platform to give a clear picture as to what is considered to be confidential information
  • It clearly indicates the consequences in case the signee breaks the agreement
  • It is a valid proof in the court of law

Writing a Patient Confidentiality Agreement

A patient confidentiality agreement is a legal document. Thus, consulting a legal expert would give an idea as to what should go into it. Analyze with care as to the terms and conditions that should primarily be part of the agreement. There is no need to include any information that you choose not to reveal. Make the agreement readable by breaking it down into short paragraphs or points. You can also see Basic Confidentiality Agreement.

We have an impressive collection of Patient Confidentiality Agreements which can be customized as per your needs. Ready to be printed out, these agreements are compatible with all operating systems. In case, you need us to make any changes to our agreements, feel free to offer your suggestions.

by Abigail Breslin

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