Medical Confidentiality Agreement

A medical confidentiality agreement is an agreement which is signed between a doctor or physician and the patient. This agreement lays down the terms and conditions which have to be agreed by both the parties till the course of the agreement.

Sample medical confidentiality agreement:

This medical agreement is signed on 24th Dec, 2010 and the parties involved are the DOCTOR and the PATIENT.

Details of the doctor:

Name: Dr. Rad Ciffling

Clinic Address: 45-y, second floor, G district, CA

Designation: General physician

Contact: 474394798349

Details of the patient:

Name: Miss Sarah James

Address: 6-h, tell street, CA

Contact: 4934843795

The length of contract: 12 months from the date of signing

Both the parties involved hereby agree to the following terms and conditions:

  • The doctor agrees to keep all the medical records, history, medication details and other confidential information within his reach and not to be shared even with the clinic staff till the expiry of the contract.
  • The patient agrees to hold the doctor responsible in case of any misconduct or leakage of the confidential information.
  • The doctor holds the right to examine the patient for any improvement or degradation of the medical condition during the term of the contract.


Rad ciffling               Sarah James

Category: Confidentiality Agreements

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