Confidentiality Acknowledgement Form for SVdP georgia Pharmacy Volunteers

Volunteers, interns or other individuals participating in any shadowing experience or unpaid tasks at St. Vincent de Paul Georgia Pharmacy (“Pharmacy”), have an obligation to treat all information about Pharmacy clients in a strictly confidential manner. In the course of your interactions at the Pharmacy, you may have access to or be given information from a variety of sources including clients, staff, other volunteers, or external partners. You are prohibited from discussing or sharing information with anyone who does not have a need to know the information, including other volunteers or staff members of the Pharmacy or the St. Vincent de Paul Georgia organization. Only individuals with a need to know the information in order to perform their job functions should have access to or be given confidential client information. Confidential client information includes any individually identifiable information about a client that relates to their healthcare, a health condition, payment for healthcare, insured status, financial information, family history information, or other information that you know or should know would not be publicly available and was shared with an expectation of privacy. Discussing or sharing any confidential information, whether electronically, orally, or in hard copy with friends, family, neighbors, client relatives who have not been authorized to receive the information, on social media, or others who do not have a need to know, is prohibited.

Healthcare providers such as the Pharmacy use information about clients to determine what pharmacy services they should receive. Ask yourself before looking at any confidential information:

  • Do I need this in order to do my job and provide quality care?
  • What is the least amount of information I need to do my job?

Depending on your task, if you do not need to know confidential information, then you should not access it.

If you are approached by the media or are requested to speak with the media, you should direct the individual to Pharmacy Director, Dr. Samantha Ricks at When discussing your volunteer, internship, or shadowing experience, please keep confidentiality in mind at all times and do not share individually identifiable information (including for example, names, photographs, email addresses, phone numbers, etc.) or any other confidential information. You are strictly prohibited from taking any photographs or videos of any Pharmacy clients or any locked Pharmacy space.

Ways to protect a client’s privacy:

  • Keep discussions about client care private if reasonably possible by closing doors, pulling curtains, and conducting discussions so that others cannot overhear.
  • Keep pharmacy records with confidential information locked and out of public areas. Do not leave confidential information on a desk unattended.
  • If you overhear someone discussing client information, politely remind the individual of the privacy policies and let them know they can be overheard.
  • Do not release any client information to a third party, unless authorized by the client, or as otherwise permitted under Pharmacy policy and state law. If you have any questions about whether information can be shared, consult the Pharmacist in Charge.
  • Do not discuss or share confidential client information with family members, friends, and/or anyone outside of the Pharmacy that is not authorized to have that information.
  • Do not leave messages on answering machines regarding client health conditions or medications.
  • Do not post any confidential information on social media.

Questions about the Pharmacy’s privacy policies should be directed to the Pharmacist in Charge at You will not be retaliated against for filing any complaints or reporting privacy concerns.

I agree to keep all confidential information, including health information relating to Pharmacy clients, in strict confidence. I understand that failure to do so will result in the termination of my participation in any volunteer, internship, or shadowing experience and may expose me to legal liability.

MM slash DD slash YYYY