- Sim Task Force
- Purpose of Policy and Procedure
- Initial Step
- Hours of Operation
- Request Form/Scheduling
- Technical Support
- Scenario Writing
- Fee & Charges for External Users
- Consent and Confidentiality
- Feedback and Evaluation
- Confidentiality Agreement
- Simulation Lab Request Form
Policy and Procedure - Confidentiality Agreement
As a patron of the Simulation Lab, I understand the significance of confidentiality with respect to information concerning simulated patients and fellow students. I will uphold the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and any other federal or state laws regarding confidentiality. I agree to report any violations of confidentiality that I become aware of to my facilitator or instructor.
I agree to adhere to the following guidelines:
- All patient information is confidential and any inappropriate viewing, discussion, or disclosure of this information is a violation of CCRI policy.
- This information is privileged and confidential regardless of format: electronic, written, overheard or observed.
- I may view, use, disclose, or copy information only as it relates to the performance of my educational duties. Any inappropriate viewing, discussion, or disclosure of this information is a violation of hospital policy and may be a violation of HIPAA and other state and federal laws.
- The simulation lab is a learning environment. All scenarios, regardless of their outcome, should be treated in a professional manner. The student running the scenario should have everyone’s respect and attention. Situations simulated in the lab are to be used as a learning tool and not to be used for humiliation of fellow students.
- The simulation mannequins are to be used with respect and be treated as if they were live patients.
- No Betadine, no ink pens (near the mannequins), 22g IV or smaller for IV starts.
Printed Name: ____________________________________________________
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