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Tri County Community Dental Clinic Confidentiality Statement As an employee of, or volunteer/student at, Tri County Community Dental Clinic, I understand that I will come in contact with confidential patient and business information. This information may be about the clients we serve, staff, volunteers, or business matters. I agree not to divulge this information to anyone other than Health Center staff on a need to know basis during or after my employment. I certify that I have read and understand this Confidentiality Statement and agree to abide by the policies and procedures Tri County Community Dental Clinic. I understand that failure to comply with the Confidentiality Statement may lead to disciplinary action up to and including termination of employment or clinical experience at Tri County Community Dental Clinic. ________________________________________ Print Name ________________________________________ Signature _____________________________ Date