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PATIENT FAMILY ADVISORY COUNCIL (PAC)
CONFIDENTIALITY STATEMENTPatient advisory Council members must sign confidentiality statements as part of their
membership processing.
A federal law called HIPAA
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How to fill out pfac confidentiality agreement

How to fill out pfac confidentiality agreement
01
Obtain a copy of the PFAC confidentiality agreement form. This can usually be found on the organization's website or by contacting the appropriate department.
02
Read through the entire agreement carefully to understand its terms and conditions.
03
Fill in your personal information, including your full name, address, phone number, and email address.
04
If required, fill in the name of the organization or entity with whom you are signing the agreement.
05
Review the confidentiality obligations section and ensure you understand what information should be kept confidential and how it should be handled.
06
Sign and date the agreement at the designated spaces.
07
If necessary, have any required witnesses also sign the agreement.
08
Make a copy of the signed agreement for your records.
09
Submit the original signed agreement to the appropriate department or person as instructed by the organization.
Who needs pfac confidentiality agreement?
01
Anyone who will have access to confidential information related to the PFAC (Patient and Family Advisory Council) may need to sign a PFAC confidentiality agreement. This can include council members, staff members, volunteers, or anyone else who may come into contact with sensitive information.
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