Confidentiality Statement
Occupational Therapy Assistant Program
Throughout the Occupational Therapy Assistant Program at Indian Hills Community College, I (name),
, will have access to patient information. I realize that this
information is private and should be kept confidential. All patient information that I have access to is personal and
private; therefore, I understand that any violation of this “patient right” is a HIPPA violation and would be possible
cause for dismissal. Violation would include, but not be limited to: a) discussing information about a patient in an
inappropriate setting, or with someone not related to the care of the patient; b) taking pictures of the patient for
personal keeping; c) exposing a patient unnecessarily; d) inappropriate handling of personal possessions of the
patient, such as going through a patient’s purse/wallet without authorization by the patient; e) posting patient
or facility information with any patient related content into social media outlets. All students will adhere to the
HIPAA (Health Insurance Portability and Accountability Act) regulations of the facility they are attending. Use
of cell phones in the clinical care area is prohibited. Posting any information relating to patient care or clinical
experiences on computer social networking sites is a HIPPA violation and is strictly prohibited. This includes, but is
not limited to pictures or text that include the name of the facility; dates relating to experiences; type of treatment
or experience that the student was involved with; patient name or personal information (i.e. Age range, diagnosis);
facility sta names or conversations; or specifics of any treatment or interaction with patients, family or sta. I
realize that this information is private and should be kept confidential. I realize that any unauthorized release of
information is punishable by fine and/or imprisonment.
Throughout my education in the Occupational Therapy Assistant Program at Indian Hills Community College, I will
at no time inappropriately release confidential information and I will adhere to the Code of Ethics of the American
Occupational Therapy Association.
I understand that release of unauthorized patient information will result in immediate termination from the Indian
Hills Community College Occupational Therapy Assistant Program.
Name:
Signature: Date:
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