Confidentiality Agreement-Example


An example confidentiality agreement that was used in a technology-enhanced Care Transitions Intervention® pilot program. The example seeks agreement from patients that they will comply with the privacy practices adopted by sponsors of a personal health record (PHR) as well as the policies and procedures to respect and preserve the privacy, security, and confidentiality of PHR information.


Program planners and managers, and professionals involved in care transitions programs and compliance. Consumers/patients are the ultimate audience for the confidentiality agreement.

Helpful Tips

For other examples of confidentiality agreements, visit other sections of the ADOPT Toolkit.

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