As a health care professional who treats patients and residents of facilities (hereafter referred to as âHealth Care Professionalâ), you may have access to âconfidential information.â The purpose of this agreement is to confirm your understanding of and obtain your commitment to your duties regarding confidential information.
Confidential information is valuable, sensitive, and protected by law and the facility policies. As a Health Care Professional, you are required to conduct yourself in a strict conformance to applicable laws and the facility policies and to abide by the duties described below governing confidential information.
You will be responsible for any alteration, destruction, misuse or wrongful disclosure of confidential medical information by you and for any failure by you to safeguard any authorization codes to access confidential information. You understand that your failure to comply with the duties described below and this agreement may also result in loss of privileges to access confidential information, loss of privileges to treat patients and residents at facilities and to legal liability.
As a Health Care Professional, you understand that you will have access to such confidential medical information that may include, but is not limited to, information relating to:
Ã¢ÂÂ Patients and residents (such as medical records, private conversations, admittance information, resident financial information, etc.)
As a condition of and in consideration of your access to such confidential information, you promise that:
By signing this, I agree that I have read, understand and will comply with this agreement.
By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent
Document Blockchain ID: cCI3Amjt2K3OgZc3WGQLIgkvvimegDIFKsEOLO0rNNs1wfElMQp8aJbRkmS0n13y, Signed on: , Signor 1 given identity: firstname.lastname@example.org, email verified by user, Login with Google Secure OAuth, IP Address: , Via browser: , Running on: , Language: , Timezone: , Resolution: , Destruction Date: , Document last modified prior to signature:
ThisÂ website has elected to useÂ electronic signaturesÂ as the default choice in lieu of paper. Be advised that according to the U.S. Federal E-SIGN Act in addition to various state laws an electronic signature is legally the same as a paper and ink signature. Also be advised in event enforcement is needed, all signatures are held in trust by SwiftSignature.com, as a neutral 3rd party, and may be legally enforced in court of law as per the terms of your respective contract.
Federal law requires certain safeguards to ensure that both consumers and vendors have the capability to receive copies of documents upon signature and are advised of the consequences of agreeing to receive documents electronically. Federal law also requires your consent to use e-mail and electronic versions of said contract and/or agreements, disclosures, and other documents and records, herein referred to as simply "electronic documents" that would otherwise be legally binding only if provided to you on paper as a printed physical document.
Electronic Documents for purpose of this disclosure include any documents signed using the Swift Signature service. All documents once signed cannot be revoked or canceled and will be stored for a minimum period of ten (10) years, and are available to either party at any time through our electronic web portal.
All signors are automatically entitled to a free document storage account within Swift Signature, the cost of which is given to you by the owner of this website. After signature, you may follow the prompts to save your document to your free account, where it will be accessible for a minumum of 10 years. This account is optional and available as a courtesy to you.
Note you do have the right to withdraw your consent to receive and/or use electronic documents, but be advised this does not cancel or revoke any prior documents for which permission existed at that time. The legal validity and enforcementÂ of electronic documents, signatures, and deliveries used prior to revocation of consent will not be affected. To withdraw your consent, please contact the owner of this website.
You have the right to have any document in paper form, should you choose at no charge to you. To request paper documents, please contact the party who referred you to this service.
By clicking "Sign and Send" on any document posting to SwiftCloud servers, you are agreeing to the terms contained herein, and are providing your consent to the use of electronic documents and signatures, as well as e-mail or sms phone message delivery of related electronic documents. You are also acknowledging receipt of this disclosure.
Hardware & Software Requirements
Acknowledgement of your access and consent to electronic records and electronic signature
By clicking "Sign & Send" on any document posting to this service, you agree that
Electronic Signature Â Â Â Â Â Disclosure & Consent