MEDICAL MISSION CONFIDENTIALITY AGREEMENT
Our Commitment
The Sisters of Mary Boystown and Girlstown Inc., DBA Sisters of Mary World Villages for Children (“Organization”), are entrusted with the health, care, dignity, and formation & protection of the children they serve. Medical and other volunteers are held to the highest standards of respect, discretion, integrity, confidentiality, professionalism, and ethical service.
1. Purpose
This Agreement ensures that all volunteers protect the privacy, dignity, and well-being of the children, Sisters, staff, donors, other volunteers, graduates, and partners, and that all service is carried out in a manner consistent with the mission of the Organization.
2. Confidentiality & Protected Health Information
Medical volunteers may have access to sensitive personal and health information (“Confidential Information”), including Protected Health Information (PHI).
The Volunteer agrees to:
- Maintain strict confidentiality of all information encountered
- Use information solely for the purpose of providing care
- Not disclose any information without prior written authorization from the Sisters of Mary
- Uphold privacy standards consistent with HIPAA principles
- Hold all Confidential Information in strict confidence, including personal information regarding children, graduates, Sisters, staff, donors, or volunteers
- Keep in confidence financial or fundraising information enountered
- Not disclose internal communications, reports, or strategies encountered
- The Volunteer agrees to maintain strict confidentiality regarding all information obtained during the course of service, including but not limited to personal information about children, families, staff, Sisters, graduates, and donors.
- The Volunteer agrees to communicate all suggested treatment plans and any health concerns promptly and directly to the Sister of Mary serving as the on-site liaison for the medical mission trip. Any critical or urgent concerns must be communicated to the Sisters both verbally and in writing prior to the conclusion of the mission trip.
3. Media & Documentation Restrictions
To protect the dignity of the children, graduates, Sisters, staff, volunteers, and community:
- No documentation or case material may be used or shared externally
- Photos, videos, or recordings of medical care, patient interactions, or any identifiable individuals may not be taken or shared. We welcome you to share your overall experience and non-medical moments, provided all content respects the dignity and privacy of the children and the community, and is approved by the site. Please note that, depending on your location of service, sharing may be limited or not permitted.
- Do not post, publish, or share in a way that identifies individuals or sensitive situations
- Confidential information shall not be disclosed to any third party without prior written consent of the Organization.
4. No Public Narratives
Volunteers agree:
- Not to share stories, case examples, or experiences publicly
- Not to use any experiences for teaching, marketing, or fundraising without express written permission
- Not to reference identifiable individuals or situations in any format at any time
5. Professional Conduct & Boundaries
All volunteers must:
- Maintain strict professional boundaries at all times
- Refrain from giving money, gifts, or personal items to individual children
- Not exchange personal contact information with children
- Follow all Sisters of Mary policies and on-site guidance
6. Duration
These obligations apply during volunteer service and continue indefinitely thereafter.
7. Breach
Violations may result in:
- Immediate dismissal from the mission
- Reporting to appropriate authorities or licensing bodies if applicable
- Possible legal action if warranted for damages or injunctive relief
Acknowledgment
I have read, understood, and agree to abide by this Agreement.
Volunteer Name:
Signature:
Date: