MMC Confidentiality Agreement

The following confidentiality agreement must be signed when attending any Munson Medical Center sponsored CME activity:

When signing the confidentiality agreement as a participant of a Munson Medical Center (program sponsor) CME Activity, you agree to the following: It is the legal, moral, and ethical duty of all participants attending education programs to assure each patient’s privacy and hold in strict confidence any and all information concerning health status, care and treatment needs, and prognosis discussed.  Some information and data presented may also be protected under Michigan statutes for quality improvement and peer review.

Because of this: I shall not actively seek to obtain any information regarding a patient’s health status beyond which is necessary to effectively perform my job. This includes any type of patient information such as: medical records, billing records, schedules and logs, data available in all computerized systems, quality improvement/peer review documentation, and verbal exchange or discussion.

I will not divulge or discuss patient information discussed in this education activity within hearing range of other patients or family members, in any public areas of the hospital, or in community settings. The only such discussions I shall have concerning such matters will be with the physicians, nurses, or clinical staff caring for the patient.

I realize that my failure to comply with these requirements may result in suspension of my privilege to attend education programs sponsored by Munson Medical Center, suspension of my privileges, and/or my privilege to call upon Munson Healthcare and could result in a legal action against me and/or my company by the patient and Munson Healthcare.