Privacy Checklist for Visitors and Observers

Often times healthcare providers would like a student or non-employee to observe them in the healthcare setting for an educational experience.  As these observational experiences involve the exposure of patient’s protected health information, the below visitor and observer guidelines were developed to ensure a consistent approach to confidentiality, health, safety and compliance at UCSF.

• Observations cannot exceed three days.  Contact Kelly Anglim in Human Resources with any questions: [email protected].
• Observer must have evidence of a recent (within 6 months) TB test and current seasonal flu shot. Evidence should be sent to [email protected]
• Observer must sign the UCSF Liability Waiver Form
• Observer must sign the UCSF Confidentiality Statement
• Before observing a medical procedure, the patient, observer, and attending physician/RN must sign the "Consent For Presence of Observer During Medical Procedure and Nursing Care"
• Signed documents should be maintained by the department for 6 years. The signed “Consent for Presence of Observer During Medical Procedure and Nursing Care” should be scanned into the patient’s medical record.

Additional Forms/Information:

• Sample Language for an Attendee Sign-in Sheet — To be used for any educational program involving non-UCSF attendees in which PHI may be shared.
• "UCSF Volunteer Confidentiality Statement for Minors" — To be signed by the parent/guardian of minor observers who may be informal visitors or participants in a formal volunteer program.