1700 South Tamiami Trail
Sarasota, FL  34239-3555
MEDICAL INFORMATION CONFIDENTIALITY STATEMENT FOR VENDORS, SALES REPRESENTATIVES AND SERVICE TECHNICIANS
It is the policy of Sarasota Memorial Hospital (SMH) to strictly maintain the confidentiality of all patient medical information, including but not limited to, medical record information and documentation and to protect each patient’s right to privacy.
Except as provided by SMH Policy #00.PER.14, Confidential/Privileged Information, the prior proper written and signed authorization from the patient, the patient’s guardian or the patient’s legal representative, or as otherwise allowed by law, patient medical information shall not be inappropriately accessed, discussed, disclosed or revealed to anyone.
I clearly understand and fully agree that I shall never inappropriately access, discuss, disclose, reveal or in any way use, either directly or indirectly, any information from the patient’s medical record or medical information relating to the care and treatment of any patient treated at SMH.  This information shall only be accessed, disclosed, revealed or used within the scope of my responsibilities and duties, to authorized users on a need to know basis as properly authorized in advance by appropriate SMH management and for legitimate SMH business purposes only.  I further acknowledge that every SMH employee is obligated to immediately make full disclosure to appropriate SMH management the knowledge of any such breach of confidentiality of patient medical information by any other SMH employee, physician, volunteer, vendor, sales representative, technician or any other person(s).
My signature on this form confirms that I have carefully read, fully understand, and agree with the Medical Information Confidentiality Statement.
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