Confidentiality Agreement

It is the responsibility of Bright Future for the Children employees, independent contractors and consultants to preserve and protect the confidential child/family, employee, and business information.

Title 34 of the Code of Federal Regulations and other applicable legal requirements for confidentiality as well as Early Intervention regulations under 10NYCRR 69-4.17 (c) – (e) under the heading Procedural Safeguards govern the release of child identifiable information as well as the acquisition and use of data that pertains to individuals. All of these laws and regulations establish protections to preserve the confidentiality of various clinical and personal information and specify that such information may not be disclosed except as authorized by law or by the child’s parent or guardian.

I understand and acknowledge that:

I shall respect and maintain the confidentiality of child/family records and any other information generated with individual child’s services.
It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all clinical/educational records, proprietary information and other confidential information relating to Bright Future for the Children. I further agree to adhere to the General Confidentiality Policy of Bright Future for the Children.
I shall only access or disseminate child/family information in the performance of my assigned duties and where required by or permitted by law, and in a manner which is consistent with officially adopted policies of Bright Future for the Children, or where no officially adopted policy exists, only with the express approval of my supervisor or designee. I shall make no voluntary disclosure of discussion, deliberations, and child/family records, except to persons authorized to receive it in the conduct of Bright Future for the Children affairs.
Bright Future for the Children performs audits and reviews child records in order to identify inappropriate access.
I agree to discuss confidential information only in the work place and only for job related purposes and to not discuss information outside of the workplace or within hearing of other people who do not have a need to know about the information.
I understand that I have a duty to protect and not to disclose sensitive information, including any and all references to HIV testing, such as any clinical test or laboratory test used to identify HIV, a component of HIV, or antibodies or antigens to HIV without appropriate authorization.
My obligation to safeguard child confidentiality continues after my termination of employment with Bright Future for the Children.

I hereby acknowledge that I have read and understand the foregoing information and that my signature below signifies my agreement to comply with the above terms. In the event of a breach or threatened breach of the Confidentiality Agreement, I acknowledge that Bright Future for the Children may, as applicable and as it deems appropriate, pursue disciplinary action up to and including my termination from Bright Future for the Children.

Your Signature

Select a date

Thanks for submitting!