VOLUNTEER STATEMENT OF CONFIDENTIALITY

I, ____________________________________, understand the basic principles of

confidentiality of patient/hospital information and will follow these policies. I have

read the “Hospital Statement of Confidentiality” below and understand this policy.

POLICY:

It is the policy of Florida Hospital Tampa to permit access by certain employees to

certain privileged and/or sensitive information in order to effectively discharge their

responsibilities. Such information may be contained in written, verbal or electronic

media forms and includes:

Information relevant to hospital operations and activities, whether actual or

planned.

Personal data related to past, present or prospective employees.

Patient medical, billing and demographic information.

User access codes for computers, doors, photocopiers, long distance calling,

etc.

Financial and budget information.

Other information considered sensitive in nature.

It is the policy of Florida Hospital Tampa that all volunteers are to be made

cognizant and understand their responsibility for maintaining the confidentiality of

such information. Confidential or sensitive information is to be held in strict

confidence and is not to be discussed with or disclosed to anyone, except as required

to properly discharge job responsibilities.

Unauthorized disclosure of confidential or sensitive hospital information by a

volunteer may result in dismissal from the volunteer department.

_________________________________________ _____/_____/_____ Volunteer Signature Date

_______________________________________________________ _____/_____/_____ Staff Signature Date