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Community College of Rhode Island

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.

Signature: _______________________________________________________

Printed Name: ____________________________________________________

Date: _________________________________

Instructor: _______________________________________________________

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Last Updated: 9/25/15