Appendix F: Confidentiality Statement

CONFIDENTIALITY STATEMENT

I have a responsibility to protect patient data. I understand that any information or data compiled for educational studies may not include or reflect patient identity, or any information that could identify the patient. I must hold in strict confidence all patient information obtained while enrolled as a student nurse in the Associate Degree Nursing Program at Moberly Area Community College.

I further understand that HIPAA (Health Insurance Portability and Accountability Act) federal legislation governs the confidentiality of healthcare practitioners, and nursing students are expected to comply with these rules. Failure to comply and/or wrongful disclosure of information may subject the individual to civil and criminal penalties as prescribed by law, including fines up to $1.5 million and imprisonment. Any breach in confidentiality may result in dismissal from the program.

Date: _________________________________________________

Printed Name: __________________________________________

Student Signature: _______________________________________