Medical Student Patient Information Confidentiality Agreement

This Confidentiality Agreement ("Agreement") is entered into by the undersigned medical student participating in clinical rotations, internships, observerships, or other educational activities at

1. Confidentiality Obligation

I understand that in the course of my educational activities, I may have access to confidential patient information, including personal, medical, and financial records. I agree that:

I will keep all patient information strictly confidential.
I will not discuss, disclose, or transmit patient information in any form, except as required for educational purposes and only with authorized personnel.
I will comply with all applicable laws, institutional policies, and ethical standards governing patient confidentiality and privacy, including but not limited to HIPAA (if applicable).

2. Security Measures

I will not access patient information without proper authorization.
I will not share my login credentials or allow others to access patient information using my identity.
I will securely dispose of any notes or documents containing patient information when no longer needed.

3. Duration

This obligation of confidentiality survives the completion of my educational activities and remains in effect indefinitely.

4. Acknowledgment

I acknowledge that violation of this agreement may result in disciplinary action, including termination from the educational program, and possible legal consequences.
I certify that I have read, understood, and agree to abide by the terms of this Confidentiality Agreement.

Medical Student Name: Signature: Date:

Witness Name: Signature: Date: