University of Kansas School of Nursing
CONFIDENTIALITY STATEMENT

I understand that during my clinical rotations I may have access to confidential information about clients, patients, their families and clinical facilities. I understand I must maintain the confidentiality of all verbal, written or electronic information and in some instances the information may be protected by law, such as state practice acts or other regulatory standards. In addition, the client’s right to privacy by judiciously protecting information of a confidential nature is part of the health professionals expected ethical behavior.

Through this understanding and its relationship to professional trust, I agree to discuss confidential information only in the clinical setting as it pertains to patient care and not where it may be overhead by visitors and/or other patients. During each clinical rotation in the clinical education program, I agree to follow each agency’s established procedures on maintaining confidentiality.

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STUDENT PRINTED NAME

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STUDENT SIGNATURE

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DATE

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SCHOOL

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EDUCATION PROGRAM

Print and mail your completed form to:

University of Kansas School of Nursing
Attn: Sharon Buchanan
3901 Rainbow Boulevard Mail Stop 4043
Kansas City, KS 66160

Or fax your completed form to: 913-588-1660 Attn: Sharon Buchanan