HOPE Family Health policy and federal regulations protect the privacy of our patients’ health information. The Health Insurance Portability and Accountability Act (HIPAA) is a set of federal rules that defines what information is protected, sets limits on how that information may be used or shared, and provides patients with certain rights regarding their information. HOPE has its own policies and procedures that reflect these regulations as well as best ethical standards.

These rules protect information that is collected or maintained, (verbally, in paper, or electronic format) that can be linked back to an individual patient and is related to his or her health, the provision of health care services, or the payment for health care services. This includes, but is not limited to, clinical information, billing and financial information, and demographic/scheduling information. Even the fact that an individual has received care at HOPE is protected by HOPE policy and federal regulations.

HOPE policy and HIPAA regulations limit the use or sharing of protected patient information to the following purposes: providing treatment, obtaining payment for services, certain health care administrative functions and when required or permitted by law. Any other use or disclosure of protected information requires written authorization from the patient. For all uses or disclosures other than treatment, only the minimum amount of information necessary will be shared on a need to basis. The Statement of Privacy Practices describes to patients how we may use or disclose their health information and patient rights regarding their protected health information. To read this statement please click here.


As a staff member, student, contractor, volunteer, visitor or any other type of business associate at HOPE Family Health, you are required to conduct yourself in strict conformance to all applicable laws and HOPE Family Health policies and procedures governing confidential information. Simply by being in one of HOPE’s facilities, you may encounter confidential patient information. Care is at times coordinated in semi-public environments where there is the risk that patient information may be heard or viewed by individuals not directly involved in the patient’s care. HOPE has polices intended to limit the risks of such incidental disclosures of patient information.

You may see or hear information related to HOPE patients (such as charts and other paper and electronic records, demographic information, conversations, admission/visit dates, names of medical and/or behavioral health providers, patient financial information, etc.). Any patient information you see or hear, either incidentally or by conducting routine and/or assigned tasks, must be kept confidential. By signing below, you are agreeing to abide by HOPE’s policies and procedures regarding confidentiality of patient health information.

As a condition of and in consideration of, my use, access, and/or disclosure of confidential information, by signing below, I understand and agree to the following:

I agree that I will access, use, and disclose confidential information only as permitted by HOPE’s policies and procedures. I understand that this means that I will only access, use, and disclose confidential information that I have been given authorization to access, use, and disclose. *
I understand that any fraudulent application, violation of confidentiality or any violation of the above provisions will result in the termination of my privileges, employment, internship, or any other type of affiliation(s) I may have with HOPE Family Health and such actions may be subject to legal liability as well. *
I understand that my signature below, and submission of this form, indicates that I have read, accept, and agree to abide by all of the terms and conditions of this Agreement and agree to be bound by it. *