HIPPA and HITECH

I acknowledge that I have received training regarding HIPAA Compliance and understand that, as an employee of AABR, I am required to adhere to all HIPAA related policies, procedures, and laws that govern AABR and all its employees.

I understand that I am not to disclose information regarding any individual with regard to their identification (name, gender, ethnicity, diagnosis), treatment, services, or payment to any person who is not a related family member or guardian.

I understand that I am also not to disclose information regarding any individual with regard to their identification (name, gender, ethnicity, diagnosis) treatment, services or payment to any person who is not employed by AABR, inc or who was formerly employed by AABR and is not involved in the care, treatment or billing of said individual.

I am able to communicate with only those individuals who provide treatment or who are involved with oversight of services and/or billing as related to a individual(s) in my care.

Full Name

Signature (Re-type name, this will count as your signature)

Title

Your Email

Date (DD/MM/YYYY)