Common Contracts
1 similar Shadowing Agreement contracts
ContractShadowing Agreement • January 1st, 2021
Tripler Army Medical Center Observation/Shadowing Agreement(Application, Wavier, Release, HIPAA, Confidentiality Statement and Policy) AUTHORITY: 5 U.S.C. section 552a, 10 U.S.C. section 2164 and 20 U.S.C. sections 921-932 and AR 40-562, Immunization and Chemoprophylayis for the Prevention of Infectious Diseases.PRINCIPAL PUROSE: To obtain immunization information needed to enroll individual in the Tripler Army Medical Center health system to promote a safe hospital environment.ROUTINE USES: Tripler Army Medical Center may release information without prior consent within the Department of Defense when needed to perform an official Department of Defense duty.DISCLOSURE: Providing information requested on this form is voluntary; but failure to provide all requested information may result in the delay or denial of individual request. OBSERVER STATUS High School/College Student Pre-Med Student Other: OBSERVER INFORMATION Last Name First Name M.I. Address Apartment/Unit #
