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SHELTER CONFIDENTIALITY AGREEMENT <br />Consistent with applicable state and federal laws, the Principles of Ethics of both the American <br />Medical and Hospital Associations, and established shelter policies and procedures, individuals who <br />may come in contact with patients, information, and records, whether medical, financial, or any other <br />— whether electronic, written, spoken or signed, I agree to safeguard and protect confidential <br />information. <br />❑ I understand that the unauthorized access, use, copy, disclosure, or dissemination of any <br />confidential information or records whether stored in hard copy, film, or electronic form is <br />strictly prohibited. <br />❑ I acknowledge my legal and ethical obligation to maintain the confidentiality of all information <br />pertaining to the shelter, its volunteers, and its shelter residents. <br />❑ I understand that accessing confidential information or allowing access by unauthorized <br />individuals, whether intentional or not, or any other breach is grounds for immediate and <br />permanent dismissal from the shelter and will be investigated and possibly reported to applicable <br />local, state and federal authorities. <br />❑ I will contact shelter administrators immediately if I believe any confidential information may <br />have been compromised. <br />❑ I understand that I am to maintain this confidentiality agreement even after I leave the shelter. <br />I acknowledge that I have read the forgoing provisions and agree to abide by their terms. <br />Print Name <br />Signature <br />Cabarrus County EOP — Annex L — Shelter and Mass Care <br />F -6 <br />Attachment number 12 <br />Page 293 <br />