Confidentiality Agreement printable pdf download

Confidentiality Agreement

Patient’s health records and customer’s personal information are conﬁdential.

I understand that I may become aware of patient or customer information in the course of performing my duties

at (name of pharmacy)

and I am prohibited from divulging or communicating this information both during and after my employment.

I agree to respect the patient’s right to conﬁdentiality and privacy.I agree to access patient’s personal health

information only as permitted in the performance of my duties or as otherwise directed by the pharmacist.

I agree to preserve the conﬁdentiality of all clinical or patient information and to not divulge this information in

any form, except where authorized by the patient or required by law. Any breach, on or oﬀ duty, of this agree-

ment will be taken seriously. Any violation can or may result in legal or disciplinary action including dismissal.

I (name of employee)

acknowledge that I have read the conﬁdentiality agreement and understand my responsibilities as they pertain to

conﬁdentiality of personal information and agree to the principles of this agreement.

Signature of employee

Signature of Owner/Designated Manager

Date

Confidentiality Agreement