Hospice Care Patient Confidentiality Agreement

This agreement affirms the commitment of all hospice care staff and associates to uphold the confidentiality of all patient information obtained in the course of providing care, in accordance with applicable laws and professional standards.

Patient Information

Patient Name Date of Birth Patient ID/Record Number

Employee/Volunteer Information

Name Role/Title Department

Agreement

I acknowledge that all information regarding hospice care patients is strictly confidential and protected by law. I understand that unauthorized disclosure, copying, or misuse of patient information is prohibited. I agree to adhere to all organizational policies and procedures regarding patient confidentiality and to report any breaches immediately.

Additional Comments (if any)