Confidentiality and Privacy of Patient Information

Dear Student,

As a student who is rotating in this health care setting and office practice, you have an ethical and legalduty to keep patient information confidential. Federal law known as the. Health Insurance Portability and Accountability Act of 1996 (HIPAA) forbids healthcare providers from disclosing patients' protected
healthcare information, except upon written authorization by the patient or as otherwise permitted by the law.

Under the HIPAA Security and Privacy Regulations, hospitals and other healthcare providers are required to have the capacity to determine who is accessing their patients' protected healthcare information and to protect the privacy of that information. Failure to maintain patient confidentiality, accessing patient information without a need to do so for your work, or any other violation of policy, may result in disciplinary action against the student, resident or fellow.

Some general guidelines:

• Access patient information only if you need that information to do your work.
• Share or discuss patient information only if it is necessary to do your work and only in appropriate locations.
• If there are electronic health records, never share your identification number or password, and log off computer sessions when you will be away from a workstation.
•  Follow the health care system and provider's policies on confidentiality and privacy.
• Ensure confidentiality when you handle all protected healthcare information.

Student Agreement

I have received and reviewed all information that I was given about patient privacy and confidentiality. I
understand there are rules regarding the use and disclosure of patient protected healthcare information,
and I agree to abide by such rules and keep protected healthcare information confidential. I understand
there are both educational and legal
punishments if I violate this policy. I recognize that I may be immediately removed and excluded from
this program, if I do not comply with this Confidentiality and Privacy Agreement.

Statement of Ethical Professional Practice

Shenandoah Medical Care Center’s (SMCC) students shall behave ethically. A commitment to ethical professional practice includes an overarching principle that express our values, and standards that guide our conduct.

Principles

SMCC’s overarching ethical principles includes: Honesty, Fairness, Objectivity, and Responsibility. Students shall act in accordance with these principles and shall encourage others within the organization to adhere to them.

Standards

A Student’s failure to comply with the following standards may result in disciplinary action.

I. Competence

Each student has a responsibility to:

1. Maintain an appropriate level of professional expertise by continually developing knowledge and skills.
2. Perform professional duties in accordance with relevant laws, regulations, and technical standards.
3. Provide decision support information and recommendations that are accurate, clear, concise, and timely.
4. Recognize and communicate professional limitations or other constraints that would preclude responsible judgement or successful performance of an activity.

II. Confidentiality

Each student has a responsibility to:

1. Keep information confidential except when disclosure is authorized or legally required.
2. Inform all relevant parties regarding appropriate use of confidential information. Monitor subordinates’ activities to ensure compliance.
3. Refrain from using confidential information for unethical or illegal advantage.

III. Integrity

Each Student has a responsibility to:

1. Mitigate actual conflicts of interest; regularly communicate with business associates to avoid apparent conflicts of interest. Advise all parties of any potential conflicts.
2. Refrain from engaging in any conduct that would prejudice carrying out duties ethically.
3. Abstain from engaging in or supporting any activity that might discredit Shenandoah or the profession.

IV. Credibility

Each Student has a responsibility to:

1. Communicate information fairly and objectively.
2. Disclose all relevant information that could responsibly be expected to influence an intended user’s understanding of the reports, analyses, or recommendations.
3. Disclose delays or deficiencies in information, timeliness, processing, or internal controls in conformance with organization policy and/or applicable law.

V. Resolution of Ethical Conflict

In applying the Standards of Ethical Professional Practice, you may encounter problems identifying unethical behavior or resolving an ethical conflict. When faced with ethical issues, you should consider the following courses of action:

1. Discuss the issue with your immediate supervisor except when it appears that the supervisor is involved. In that case, present the issue to the next level. If you cannot achieve a satisfactory resolution, submit the issue to the next management level. Communication of such problems to authorities or individuals not employed or engaged by the organization is not considered appropriate, unless you believe there is a clear violation of the law.
2. Clarify relevant ethical issues by initiating a confidential discussion with Shenandoah’s management or other impartial advisor to obtain a better understanding of possible courses of action.
3. Consult your own attorney as to legal obligations and rights concerning the ethical conflict.

Acknowledgement and agreement:

“Confidential Information” includes information relating to:

• Any individuals Protected Health Information (PHI), which is information that identifies an individual (name, social security number, account number, etc.) and is created or received by a health care provider, health plan, or healthcare clearinghouse, is transmitted or maintained in any medium (i.e. electronic medical record, paper, oral) and relates to the past, present or future physical or mental health condition, or payment for the provision of care (including medical records, conversations, admitting information, and patient financial information)
• Students (including medical records, compensation, benefits, student records, and disciplinary actions)
• SMCC’s specific information (including financial and statistical records, strategic plans, internal reports, memos, contracts, peer review information, communications, proprietary computer programs and technology and source code).
• Proprietary third-party information (including computer programs and technology, client or vendor information and source code).

I understand and agree as follows:

1. As a student of SMCC, I may learn of or have access to Confidential Information through computer systems (including, but not limited to patient care information systems, other clinical and financial information systems, or student records through my tenure.
2. I will use Confidential Information/PHI only as minimally necessary to perform my legitimate student duties, as well as safeguard and limit access to any Protected Health Information in any medium (including written, oral or electronic formats).
3. I will safeguard access to Confidential Information, or any Confidential Information/ PHI.
4. I will protect any and all PHI obtained as a student after my tenure has ended with SMCC.
5. I understand that SMCC may routinely monitor and audit access to information regarding, but not limited to, students and patients, their relatives, public figures, and VIPs for appropriateness of access to such information as it relates to my legitimate duties.
6. I will sign off the computer when I leave the computer system.
7. I understand that I am responsible for all activity logged under my password. I understand that I must log off before another may use the computer.
8. E-mail system will be used in ways consistent with SMCC’s E-mail, Internet Use and Standards policy.
9. I will notify my teacher immediately if I suspect or learn that my access code, other authorization for access to Confidential Information or any Confidential Information has been misused or disclosed without proper authorization. I understand the purpose of this notification is to protect confidentiality by having my unique information systems access code(s) changed.
10. SMCC may, at any time, revoke my access code or other authorization for access to Confidential Information.
11. A violation of this agreement will subject me to discipline, including, if warranted, termination of my student tenure.
12. I understand that violation of my duties as discussed above may independently constitute a violation applicable criminal/civil law.

Nurse Practitioner Student Financial Agreement

Prior to the start of the clinical rotation, all students must agree to the Student Financial Agreement. The Student Financial Agreement acknowledges that a signed contract creates a financial obligation to Shenandoah Medical Care Center. The agreement also clarifies, withdrawal and non-payment conditions. Any questions regarding the Student Financial Agreement can be directed to the Business Office at (561) 619-9510 and info@shenandoahmedical.com.

I understand and agree that once I have signed the contract, I am solely responsible for the payment of the resulting tuition, fees, and any other charges that I have authorized to be posted my account. I fully understand, acknowledge and agree that regardless of any expected reliance by me on any third-party resource, including, without limitation, financial aid, employer reimbursements, scholarships, or any other external resource, I am and remain personally responsible for paying any and all balances due to Shenandoah Medical Care Center. This agreement constitutes a continuing agreement obligating me to pay all outstanding balances due Shenandoah Medical Care Center.

Fee

Application Fee: Nonrefundable $40 – This includes processing and submission of university/school required documentation, such as collaborative agreement, practice/provider CV/resume, etc.
Hourly Rate*: $12/hour, i.e. 50 hours required for course = 50 x 12 = $600 (excluding Application Fee)
*50% of clinical hours’ fee is required to hold student’s spot prior to the start of the rotation

Withdrawal Policy

Contract agreement creates a financial obligation to Shenandoah Medical Care Center. A refund is only effective upon receipt of an official notice. Registration, enrollment and document collection service fees will not be refunded once contact has been initiated with your program director. Once the student has completed at least one (1) hour of clinical hours, they will only be eligibility for a partial refund. Once the student has completed a quarter (1/4) of their required clinical hours, they can be refunded half of the financial obligation. Once the student has completed at least half of their required clinical hours, no refund will be allowed. Non-attendance is not a leave-taking from the program; therefore, the student is still required to submit payments as agreed upon.

Failure to Pay & Collections for Nonpayment
I understand that if my account should lapse into delinquent status, I will receive a sign off on clinical hours, and will not be allowed to return to the clinical experience until my bill is paid. Please note that it is Shenandoah Medical Care Center practice discretion to place delinquent accounts with an outside collection agency at the end of each term. I agree to reimburse Shenandoah Medical Care Center the fees of any collection agency, which may be based on a percentage at a maximum of 33% of the debt, and all costs and expenses, including reasonable attorney fees, that Shenandoah Medical Care Center incurs in such collection efforts.

Authorization

I authorize Shenandoah Medical Care Center and their respective agents/contractors to contact me regarding my student account at the current and/or future emails and numbers that I provide for my cellular phone or other wireless device using automated telephone dialing equipment or artificial or pre-recorded voice or text messages.

Acknowledgement 

I hereby acknowledge that I have read this Agreement and fully understand it. By signing below, I am agreeing to be bound by all the terms of this Agreement, thereby obligating me to pay all outstanding balances that I may incur with Shenandoah Medical Care Center now and in the future.