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Required fields are marked with *

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Recognizing confidentiality as a basic right, all Mercy Medical Center staff shall preserve the confidentiality of patients, employees and medical center information.

Unauthorized release, inappropriate exchange, or mishandling of confidential information is a source of potential liability for the hospital and is thus subject to disciplinary action.

As a medical student or resident of Mercy Medical Center, all information exchanged concerning patients, families, and employees will take place on a “need to know basis” in order to fulfill job responsibilities.

Therefore:

I have read and understand the above confidentiality contract and agree to abide by the statements set forth. In so doing, I embody the Mercy values of Integrity, Compassion, Accountability, Respect and Excellence.

My electronic signature will constitute my "original" signature as well as my Acknowledgement and Certification of the applicable statement(s) when used or printed. A copy of this form will be maintained in my medical student or resident file and I can receive a copy at any time from Mercy Physician Relations:

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