Confidentiality Worksheet
Confidentiality Worksheet
Name _______________________________ Date _________________
Completing this worksheet as you go through the web-based confidentiality tutorial will reinforce some of the key points. Your completed worksheet will also serve as a guide for discussing this topic with your supervisor. Put an * next to any items that were new to you. Put a ? next to anything you’re not sure you understand.
1. What harm could result from identifying someone as receiving services from this Department?
______________________________________________________________
______________________________________________________________
2. What is the General Rule?
_______________________________________________________________
_______________________________________________________________
3. Six things a person must understand in order to give informed approval for the use or disclosure of confidential health information.
1. ______________________________ 4. ____________________________
2. _______________________________ 5. ____________________________
3. ________________________________ 6. _____________________________
4. The 12 categories of exceptions are:
1. ________________________________ 7. ______________________________
2. ________________________________ 8. ______________________________
3. ________________________________ 9. ______________________________
4. ________________________________ 10. ______________________________
5. ________________________________ 11. ______________________________
6. ________________________________ 12. ______________________________
5. The penalty for unlawful disclosure of confidential information is _____________________
_______________________________________________________________________
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