HIPAA Confidentiality + Non-Disclosure Agreement Template

The HIPAA confidentiality and non-disclosure agreement template is a binding document used by healthcare facilities for preventing non-employees from sharing information they learned with third (3rd) parties. HIPPA (Health Insurance Portability Act) was enacted in 1996 for the effort of protecting an individual’s medical and personal information. Healthcare facilities are legally required to keep any information that can be used to identify someone, as well as information stored in physical or electronic documentation. The form is for non-employees, meaning it could be for temporary contractors, visitors, and people that will have access to sensitive information.

How to Write

Step 1 – Download the Template

The agreement can be saved in the following formats: PDF, Word (.docx), or Rich Text (.rtf).

Step 2 – Read

The agreement should be read thoroughly to ensure the signer agrees to all sections of the document.

Step 2 – The Parties

In the first field, type the name of the person agreeing not to disclose information (the non-employee). Then, enter the full name of the healthcare facility.

Step 3 – Signing

The non-employee will need to:

  • Sign their name (electronically or by hand);
  • Print their full name; and
  • Enter the date in which they signed.