VISITING NURSE GROUP, INC.

My signature verifies that I have viewed the HIPAA video and received adequate training and the training covered the following topics:

1. Principles of and need for privacy and security.
2. Requirements of HIPAA and the DHSS regulations.
3. Requirements of other Federal and State laws regulating health information.
4. Requirements of professional ethics and accreditation standards regulating health information.
5. Visiting Nurse Group, Inc.’s policies and procedures regarding health information.
6. Practical guidance for protecting data integrity and confidentiality, such as the importance of proper password procedure, how to guard against computer viruses, and the like.
7. Procedures for reporting breaches of security and confidentiality.

I certify that Visiting Nurse Group, Inc. has trained me in the above-mentioned topics, and I understand that training, particularly Visiting Nurse Group, Inc.’s policies and procedures. I agree that I will adhere to the requirements of Visiting Nurse Group, Inc.’s policies and procedures, and I understand that I face disciplinary action if I do not.

I also certify that I have been given opportunity to view Visiting Nurse Group, Inc.’s Policies and Procedures and that I have taken that opportunity to view these policies and procedures. Further, I acknowledge that I have an ongoing opportunity to view these policies and procedures whenever I choose.