Caregiver HIPAA & Confidentiality Agreement

THIS AGREEMENT MUST BE SIGNED BY ALL CAREGIVERS DURING THE ONBOARDING PROCESS.

Purpose

As a caregiver of WellTrust Home Care LLC, you may have access to confidential client information in the course of providing care services. This agreement outlines your responsibilities to protect this information in compliance with the Health Insurance Portability and Accountability Act (HIPAA), Ohio state law, and Ohio Medicaid requirements.

Confidential Information Includes

Client names, addresses, phone numbers, and other contact information
Health conditions, diagnoses, medications, and medical history
Care plans, service schedules, and treatment information
Financial information, insurance details, and Medicaid information
Family information and emergency contacts
Any other personal information about clients or their families

Your Responsibilities

As a caregiver, you agree to:

Protect confidentiality — Keep all client information private and secure
Limit discussions — Only discuss client information with authorized personnel on a need-to-know basis
Secure documents — Never leave client records or information unattended or accessible to unauthorized persons
No unauthorized disclosure — Never share client information with family, friends, or on social media
No photography — Do not take photos or videos of clients, their homes, or their belongings
Report breaches — Immediately report any suspected breach of confidentiality to WellTrust Home Care LLC
Return materials — Return all client-related materials upon termination of employment

Duration

This confidentiality obligation continues indefinitely, even after your employment or engagement with WellTrust Home Care LLC ends.

Consequences of Violation

Violation of this agreement may result in:

Immediate termination of employment
Civil liability for damages
Criminal penalties under HIPAA and Ohio law
Reporting to appropriate licensing boards and regulatory agencies

Print & Sign

Please print this page, complete the information below, and return to WellTrust Home Care LLC during onboarding.

I have read and understand this Caregiver HIPAA & Confidentiality Agreement. I agree to protect confidential client information and comply with HIPAA, Ohio law, and Medicaid requirements. I understand that violation of this agreement may result in disciplinary action, termination, and legal consequences.

Caregiver Name (Print)

Signature

Date

WellTrust Home Care LLC Representative:

Representative Name (Print)

Title

Signature

Date

Electronic Signature

Complete the form below to submit your agreement electronically.

First Name *

Last Name *

Email Address *

Phone Number *

I have read and understand this Caregiver HIPAA & Confidentiality Agreement. I agree to protect confidential client information and comply with HIPAA, Ohio law, and Medicaid requirements. I understand that violation of this agreement may result in disciplinary action, termination, and legal consequences. I understand that this confidentiality obligation continues even after my employment ends.

Electronic Signature (Type Full Legal Name) *

Date *

By typing my name above, I understand that this constitutes a legal signature confirming that I have read, understand, and agree to comply with this Caregiver HIPAA & Confidentiality Agreement.

Contact

Email: welltrusthomecare@gmail.com

Phone: (234) 704-6458

Mailing Address:
8210 Macedonia Commons Blvd, Suite 3B PMB 1080
Macedonia, OH 44056