For basic information about the Coaching Program, including our Confidentiality policies, please see our Frequently Asked Questions at https://integrityprogram.org/coachingprogram/.

We are strongly committed to protecting the confidentiality of information that clients share.

This document describes the confidentiality protections the Coaching Program offers to clients and describes expectations of all who participate. Please indicate below your agreement with these policies and expectations.

To create a safe environment for sharing, to the fullest extent of the law, the program will protect client data.  We will do the following to protect confidentiality:

• Use a HIPAA-compliant version of Zoom (or similar web meeting platform)
• Prohibit anyone other than the client and coach from being on the calls, unless with permission in special circumstances
• Prohibit audio or video recording of calls by clients or program coaches
• Require clients and program coaches to sign a confidentiality agreement
• De-identify assessment data to be used for quality improvement efforts
  • Note: If any assessment data will be gathered from clients solely for research purposes, you will be notified and we will request your consent to participate.
• Send no information to third parties without client permission (as permitted by law)
• Request your permission to share any information you provide with your institution
  • Note: We do not control what an institution communicates with us.
  • Note: You should not share any information that could create a legal liability for you.

I agree not to permit anyone on the call with my coach without his/her knowledge and permission.

__ Yes

__ No

I agree not to record P.I. Program sessions in any manner, including audio and video recordings.

__ Yes

__ No

I agree not to distribute proprietary information, which includes assessment instruments, worksheets, handouts, and other materials – unless explicit written permission is provided for a specific purpose.

__ Yes

__ No

I have read and agree to these confidentiality protections.

__ Yes

__ No

Here, we solicit information on your choices regarding communication with your institution.

We require clients’ permission prior to sharing certain forms of information with their institution.

Please indicate below your choice regarding our communication with your institution.

Your Professional Development Plan (PDP), a document outlining your professional goals and activities that will help you achieve the goals.  (Institutions may require a PDP; you may also wish to show your institution the steps you are taking to foster your professional growth.)

__ Yes, share the PDP with my institution

__ No, do not share the PDP with my institution

• Note: We do not offer our opinions about clients to their institutions, nor do we share any statements clients make during the program.

If you answered “Yes” regarding our communication with your institution above, please provide a name, job title, phone number, and email address for up to three people to whom you want us to send the relevant information.

Contact 1: ____________________________________________

Contact 2: ____________________________________________

Contact 3: ____________________________________________

If you have any questions, please do not hesitate to contact the Program Manager at integrity@wustl.edu.