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Mandatory Confidentiality Pledge *Read Carefully*
I understand that while I am visiting in this capacity, I may be exposed to "protected health information," information about a person’s health or treatment that identifies the person, and other information deemed to be confidential by other laws (collectively referred to as “Confidential Information”). I also understand that while I am visiting in this capacity I may be treated as a temporary member of Johns Hopkins’ “workforce” for purposes of the federal HIPAA privacy regulations only. I pledge and agree to use and disclose any Confidential Information only for the training, observational and/or educational purposes of my visit and otherwise to keep the information confidential. The taking of photos, videos and audio recordings is not allowed without additional permissions/authorizations. I will not post or discuss Confidential Information, including pictures and/or videos, on my personal social media sites (e.g. Facebook, Twitter, etc.). I will not access, maintain or transmit Confidential Information on any unencrypted portable electronic devices (e.g. Blackberries, Androids, iPhones, iPads, etc.) and agree to use such devices, with respect to Confidential Information, in accordance with Johns Hopkins policies only. I understand that I may direct to the Johns Hopkins Privacy Office any questions I have about my obligations under this Confidentiality Pledge or under any of the Johns Hopkins’ policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Office, Telephone: 410-614-9900, e-mail: HIPAA@jhmi.edu.

 I certify that I am visiting Johns Hopkins for observational  purposes only.

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By completing this SIGNATURE field, I warrant my acceptance and adherence to this confidentiality pledge.

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I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.