HIPAA CONTRACT
Lynn Rogers, CRS
Berrien/Clinch Counties
Nashville, GA 31639
(229) 686-5568
(229) 686-3933 (fax)
The DFCS office is sometimes used as a work experience site for TANF participants that cannot participate at the other worksites due to medical problems or other reasons. In an effort to protect the privacy of all DFCS customers, the participants are required to view the HIPAA privacy video. In addition to the video, the Community Resource Specialist talks to all participants about the importance of confidentiality, pointing out to them how they would feel violated if anyone shared their information with others.
I
developed a contract that each participant must sign after viewing the HIPAA
video. This states the clients have viewed the video and have been explained
the importance of not breeching confidentiality. Should the participant breech
confidentiality, he/she will be released from the worksite. The contract also states
the participants will conduct themselves in a professional manner at all times
and use the site to gain knowledge and work ethics for future employment
opportunities.
I
left enough space on the top of the contract so that each county could be
county specific and put the contract on letterhead.
Berrien
County Department of Family and Children Services is a non-profit worksite for
the TANF mandatory participants. While the participants are at the worksite
completing their work activity, the duties performed may include: shredding,
filing, typing, greeting, putting program packets together, answering phones,
janitorial duties, etc. The participants will often come into contact with
names of customers served by the department.
In
an effort to honor the ethics of confidentiality, each participant using the
department as a worksite is required to view the HIPAA video and have explained
the confidentiality rules to them by the Community Resource Specialist, Lynn
Rogers.
This
is to state that I, ______________________, have viewed the HIPAA video and was
explained the importance of confidentiality by the Community Resource
Specialist on ________________.
(Date)
·
I understand all information/names learned through the department are
strictly confidential and I will be released from my worksite should I breech
confidentiality.
·
I must conduct myself in a professional manner while at the department
at all times.
·
I will use the worksite to gain knowledge and work ethics that may be
used for my future employment opportunities.
___________________________ _______________
(TANF Participant Name) (Date)
___________________________
________________
(Community
Resource Specialist)
(Date)