Competency-based Curriculum: Group Visits
Recent Updates
Search
Competency-based Curriculum: Group Visits >  Example Confidentiality Agreement and Medical Waiver (Maine Med Ctr)

Example Confidentiality Agreement and Medical Waiver (Maine Med Ctr)

Last updated at 08/27/2007 10:36:14 AM EST by Traci Nolte
 
Maine  Medical  Center
 
Confidentiality Agreement:
 
As group medical visits involve patients disclosing private medical and social information, all participants during a group medical visit, whether the direct patient or an accompanying family, must agree to respect the privacy of all information and keep such information confidential. By signing this confidentiality agreement, I assume the responsibility for keeping all information confidential.
 
_____________________     ____________________________    _______________
Name                                               Signature                                                       Date
 
 
Medical Waiver:
 
Group medical visits is a form of a medical appointment. Hence by participating in a group medical visit, the patient assumes responsibility for the cost of the medical services provided and any copays involved. By signing this form, I assume the responsibility of paying for my group medical visit, and agree to pay co payments and all costs associated with this medical appointment.
 
 _____________________     ____________________________    _______________
 Name                                               Signature                                                       Date
1 comment(s) so far... Click here to comment on this page