"*" indicates required fields

CONFIDENTIALITY AGREEMENT

It is our endeavor to ensure that the operations, activities and client affairs of Helios Home Health are kept confidential to the greatest possible extent. Any staff employees or independent contractors of Helios Home Health that may acquire confidential or proprietary information of its clients or business activities will be handled in strict confidence and in accordance with HIPPA guidelines.

All staff and independent contractors are asked to sign a statement of confidentiality at the time of registration. This statement will be maintained in the individual’s personnel file.

Any breach of this statement will be in violation of HIPPA guidelines.

I HEREBY ACKNOWLEDGE THAT THE ABOVE STATEMENT HAS BEEN EXPLAINED TO ME AND UNDSTAND ITS CONTENTS.

Name (Please Print):*

Date:*

Signature:*

Phone

This field is for validation purposes and should be left unchanged.