New Volunteer Information and Paperwork

As a Volunteer or observer associated with Savannah Speech & Hearing Center, I agree to the ethical and legal standards held by the Center to respect and protect the privacy of their staff and visitors as well as all school staff and students. I therefore agree not to discuss or publicize the names or information about any individual I observe in person or see in print when I leave the center or school visited and will consider all such information to be private and confidential. I acknowledge that my own privacy will be equally respected and protected by the entirety of the staff at the Savannah Speech & Hearing Center, Inc.

I understand that The Savannah Speech and Hearing Center, Inc. does not carry or maintain health, medical, or disability insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage.

I hereby grant and convey unto The Savannah Speech and Hearing Center, Inc. all right, title, and interest in any and all photographic images and video or audio recordings made by representatives of The Savannah Speech and Hearing Center, Inc. during any and all Volunteer activities with The Savannah Speech and Hearing Center, Inc., including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

Based upon the above, I do hereby release, forever discharge and hold harmless the Savannah Speech and Hearing Center, Inc., its elected and appointed officials, officers, employees, and authorized representatives from and against any and all liability, loss, damage, expenses, costs (including attorney’s fees) arising out of or in any way attributed to the activities performed on behalf of The Savannah Speech and Hearing Center, Inc.

By making this agreement, I acknowledge that I have read it in its entirety, have given the terms due consideration, that I understand the terms and that I am freely and voluntarily giving up certain rights. I further intend that this agreement shall be binding upon all of my successors, heirs, assigns, receivers and the like.

HIPAA Confidentiality Agreement for Savannah Speech & Hearing Center:

Employees, partners, volunteers and student shadowers of the practice will have access to confidential information, both written and oral, in the course of their employment and job responsibilities. It is imperative that this information is not disclosed to any unauthorized individuals to maintain the integrity of the patient information. An unauthorized individual would be any person that is not currently an employee of the practice and/or any information. Any other disclosures may only occur at the direction may only occur at the direction of the Privacy Office or by patient authorization.
I have read and understand the practice’s policies above with regards to privacy and Security of personal health information. I agree to maintain confidentiality of all information obtained in the course of my employment, volunteering or shadowing including, but not limited to, financial, technical, or propriety information of the organization and personal and sensitive information regarding patients, employees, and vendors. I understand that inappropriate disclosure or release of patient information is grounds for my termination/dismissal.

See our Notice of Privacy Practices through the link below.