Sample Patient Medical Confidentiality Agreement - Free Download
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Sample Patient Medical Confidentiality Agreement
Sample Patient Medical Confidentiality Agreement
© HIPAA Security Suite 1 Version 1.8 12.16.13
This Confidentiality Agreement (the “Agreement”) is made and entered into between
_____________ (“Subcontractor”) and __________________________ (“Covered Entity”).
WHEREAS, Covered Entity contracts with Subcontractor to provide certain services to Covered
Entity as described in EXHIBIT 1. The parties acknowledge that Subcontractor may incidentally
or inadvertently encounter, view or access certain Confidential Information maintained by
Covered Entity which may qualify as Protected Health Information (“PHI”) or electronic PHI
within the meaning of the Health Insurance Portability and Accountability Act of 1996, as
amended, and the privacy and security standards promulgated pursuant thereto (“HIPAA”).
NOW, THEREFORE, in consideration of the mutual promises contained herein, as well as other
good and valuable consideration, the parties hereto agree as follows:
1. “Confidential Information” means any and all non-public, medical, financial and personal
information in whatever form (written, oral, visual or electronic) possessed or obtained
by either party. Confidential Information shall include all information which (i) either
party has labeled in writing as confidential, (ii) is identified at the time of disclosure as
confidential, (iii) is commonly regarded as confidential in the health care industry, or (iv)
is Protected Health Information as defined by HIPAA.
2. Subcontractor shall provide the services more fully described in EXHIBIT 1 to this
Agreement. For its services, Subcontractor shall receive from Covered Entity
compensation as agreed to in a separate contractual agreement.
3. It is agreed that there shall not be any employer/employee relationship between the
parties. Subcontractor is free to engage in any other employment of his or her selection.
It is further agreed that Subcontractor is not an agent of Covered Entity.
4. Subcontractor agrees that it does not have a need to access or view Confidential
Information to provide the services in Exhibit 1 and will not attempt to obtain access to
Confidential Information.
5. Subcontractor agrees to maintain the confidentiality of any Confidential Information,
including Protected Health Information that it may incidentally or inadvertent encounter,
view or have access to while providing the services under the terms and conditions set
forth in this Agreement.
6. Subcontractor agrees not to further use or disclose any Confidential Information,
including Protected Health Information that it incidentally or inadvertently views or
obtains access to and further agrees to implement appropriate safeguards to prevent any
further use or disclosure of any Confidential Information that is incidentally or
inadvertently accessed.
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Sample Patient Medical Confidentiality Agreement