Care Beyond The Boulevard

Confidentiality Statement

Our patients are entitled by law and by courtesy to complete privacy regarding their
diagnosis, treatment, financial and personal status.
As a volunteer of Care Beyond The Boulevard, I agree to respect and hold all
information* obtained in the course of my volunteer time with Care Beyond The
Boulevard, whether that information is obtained through written records or daily
interaction with patients/clients; except as part of my assigned or legally specified duties
to report the record or to local, state or federal agencies as required.
Obligations under this agreement regarding patient confidentiality will continue after the
termination of my volunteer time/assignment/affiliation with Care Beyond The
Boulevard. Violation of this agreement will result in disciplinary action, up to and
including termination as well as potential civil and criminal legal penalties.
Print Name: ___________________________________
Signature: ____________________________________
Date: ________________________________________

*Includes the following:

Do not access or view any information other than necessary to provide assigned
volunteer responsibilities.
Do not discuss patients by name or identifier in hallways or other public areas
where patients or visitors may hear.
Do not discuss patients outside of the course of care or reveal to nonprofessional volunteers of Care Beyond The Boulevard.
Do not share personal access codes, user IDs, access keys and passwords to
access the building, computer systems or other equipment.
Do not make inquiries about any information for any individual or party who does
not have proper authorization to access to such information.
Do not make any unauthorized transmissions, copies, disclosures, inquiries,
modifications, or purgings of patient information or confidential information.

Care Beyond The Boulevard, 340 Southwest Boulevard, Kansas City, KS 66103