Volunteer – Student Confidentiality Form

Volunteer – Student Confidentiality Form

Confidential information includes not only information labeled as such, but also includes, and is not limited to business information, patient referral lists, financial and marketing information, patient charts and information, business plans, treatment programs, proprietary materials, and all other information confidential to Ginger Fitness and Rehabilitation, Inc. (GFR).

I,  understand I am bound to Ginger Fitness & Rehabilitation, Inc. dba Ginger Fitness and dba Grace Adaptive Driving - HIPAA Policies and Procedures. I will complete the HIPAA training and submit a copy of the certificate of completion to the Administrator prior to my start date. HIPAA Training Link.

I understand that during the course of my observation and contact with GFR, I will receive and have access to Confidential information and that such Confidential information is owned by GFR. I also understand that the release of such information to third parties would cause damage to GFR. As a result, I agree not to disclose any GFR Confidential information which I receive to any third party, except as may be provided by or required by law.

I will also keep all records and information of agencies/ companies that GFR contract with confidential, as directed by GFR and those agencies/ companies' guideline for contracting.

All information and knowledge about specific patients will not be relayed to anyone else and patients' names, address, and other information is not to be divulged to a third party.

This agreement will survive termination of my contact with GFR.

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