Orientation Confirmation

I hereby state that I have read, reviewed, and completed the Ballad Health online student orientation. The information presented to me included:

  • Introduction to Ballad Health
  • Patient Rights & Responsibilities
  • Infection Prevention
  • Safety/Environment of Care Plan
  • Rapid Response Team
  • Ergonomics and Back Care
  • Corporate Compliance
  • Patient Experience
  • Diversity
  • Abuse, Neglect & Exploitation
  • Suicide Precautions/Indicators
  • Fall Risk Assessment
  • Restraints
  • Dress Code
  • Parking
  • Smoking Policy
  • Code of Ethics

Ballad shall provide emergency treatment to Instructors and Students if needed for illness or injuries suffered while participating in clinical experiences at the Clinical Sites. Such treatment shall be at the expense of the individual treated. School shall provide and maintain or shall ensure that each Student and Instructor carry and maintain health insurance. Ballad reserves the right in its sole discretion to allow or refuse a clinical rotation to any Student or Instructor without health insurance.

I understand I am responsible for medical bills for treatment I receive. I attest I carry and maintain (or am otherwise covered by) health insurance during my educational experience at Ballad.

Confidentiality Agreement

Ballad Health Confidentiality and User Agreement

Ballad Health has a long tradition of protecting the privacy of patient information, including, but not limited to patient names, addresses, telephone numbers, social security numbers, diagnoses, and information associated with the delivery of care to a patient at any Ballad Health facility. Ballad Health's commitment to patient confidentiality is reinforced by the privacy and security regulations created as part of the Health Insurance Portability and Accountability Act (HIPAA).

In addition, Ballad Health has intellectual property that must be protected. Such information may be disclosed for particular business purposes. Ballad Health business related property must not be used, copied, distributed or disclosed without appropriate authorization or contractual agreement.

I understand that maintaining the confidentiality of patient and business information is a condition of my continued relationship with Ballad Health. This includes patient and business information that may be incidentally disclosed to me as a result of my presence in a Ballad Health facility.

Therefore, I agree to maintain the confidentiality of all patient information, as well as any business-related information that may become known to me in the course of my relationship with Ballad Health during and after my affiliation with the organization.

Patient information will be managed in accordance with Ballad Health policies and all applicable state and federal requirements. Patient information will only be accessed, used or disclosed in a manner necessary to perform job duties based on a need to know.

Patient information will be protected from any intentional or unintentional use or disclosure that is in violation of Ballad Health policy and/or state and federal regulations. Any breach in confidentiality of patient information is a violation of Ballad Health policy, and such a breach will result in appropriate actions, up to and including termination of relationship with Ballad Health. In addition, such a violation may be considered a violation of federal regulations and be subject to investigation by the Office of Civil Rights.

I understand that by selecting the "I Accept" button and submitting this form, I am signing this form electronically and confirming that I have read, understand, and agree to comply with the preceding statement(s). I also understand that an electronic signature is the legally binding equivalent of my hand-written signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. By selecting "I Accept," I am confirming that I have completed and/or agreed to the following items/notices:

  • Student of Orientation Modules
  • Confidentiality Agreement Notice