Patient Confidentiality Policy All information gathered from a patient in the intake process necessary to provide service tot he patient will be considered confidential. This includes all information entered into the computer database of the Ministry. No information regarding a patient may be released to another agency, church, person, or employer without the patient's written consent. NCHM shall provide the necessary forms for the release of the information to be signed by the patient. If written consent cannot be obtained, phone consent properly documented can be used. Procedures: Particularly because many patients live int eh same community as the Board, staff, and volunteers, everyone associated with NCHM needs to be especially aware of each patient's right to confidentiality and privacy. NCHM will offer an orientation session on confidentiality and Ministry policy for all th Board, staff, and volunteers to facilitate understanding and awareness. Staff and volunteers will sign a written pledge to maintain patient confidentiality. NCHM will hold regular reviews and updates on these issues for staff and volunteers. Any new Board, staff and volunteer will be oriented to these issues as soon as possible upon starting involvement with NCHM. No information regarding patients of NCHM should be discussed or shared outside of the Ministry by Board, staff, and volunteers. Questions or concerns regarding the Ministry patients should be referred to appropriate staff. Staff, Board, and volunteers should refrain from identifying someone as an NCHM patient when the patient is seen in the communithy. All information regarding patients of the Ministry is confidential and is to be used on a "Need to Know" basis only, which means the information is provided only when a situation requires it. Staff, Board, and volunteers, because of the openness of the physical layout of the office, need to make every effort to insure the patient as much privacy and confidentiality as possible.
* First Name
* Last Name
* Address Line 1
Address Line 2
Address Line 3
* City
State
* Postcode
* E-Mail Address
* Confirm E-Mail Address
Telephone
* Name of Employer
Position
Work Hrs/Day
* Emergency Contact Name
* Emergency Contact Relationship
* Emergency Contact Phone
* How did you become interested in volunteering?
* Volunteer Experience (describe)
* Please Provide a Reference Name
* Reference #1 Address
* Reference #1 City
* Reference #1 State
* Reference #1 Zip
Second Reference Name (recommended)
Reference #2 Address
Reference #2 City
Reference #2 State
Reference #2 Zip
* How would you like to volunteer? (Please describe related skills or interests)
* Additional Info
* I acknowledge that I have read and discussed the Confidentiality Policy of NCHM and I understand how to comply with it. I agree to abide by the Confidentiality Policy of NCHM both while on-duty and off-duty at the ministry
*
I agree to these terms