Get Visitor Confidentiality Form - Patient Privacy - University Of Utah - Privacy Utah

Filling out the Visitor Confidentiality Form is a crucial step in ensuring patient privacy and confidentiality at the University of Utah Health Sciences Center. This guide provides clear instructions to help you accurately complete the form online.

Follow the steps to successfully complete the Visitor Confidentiality Form.

1. Click the ‘Get Form’ button to obtain the Visitor Confidentiality Form and open it in the designated editor.
2. Begin by locating the 'Visitor' section at the top of the form. Enter your name and address as requested. This information is essential for identifying who is making the confidentiality agreement.
3. Review the definition of 'Confidential Information' provided in the form. Take note of the types of information that you are agreeing to keep confidential, such as medical records, treatment plans, and any other patient-related data.
4. In the 'Confidential Information' clause, read through your obligations to hold all confidential information in secrecy. Make sure you understand that any disclosure to unauthorized individuals could be damaging or illegal.
5. Locate the signature area where it states 'Signature of Visitor'. Sign your name and date the form in the space provided. Ensure that your signature is legible.
6. Complete the section labeled 'Visitor’s Printed Name' and 'Visitor’s Address, Position and Affiliation' if relevant. This includes providing your official position or affiliation to clarify your purpose for visiting.
7. Know that your signature must be verified by a University of Utah Health Sciences Center staff member. Leave the section for the staff member's signature blank for them to complete.
8. If required, complete any notarization process as specified on the form to confirm your identity and signature. Ensure this is done before submitting the form.
9. Once you have filled out the form, review all fields for accuracy. After confirming all information is correct, save your changes, download, print, or share the completed form as necessary.

Take the next step in protecting patient privacy by completing the Visitor Confidentiality Form online today.