Having done as a home business in the past for a good number of years and for different organisations, it's up the individual(s) or organisation you do the work for how "fussy" they wish to be. Most of them had me sign a confidentiality agreement and a HIPAA form statin that I would keep all information confidential, and they kept a copy on file and I kept a copy. It was that simple. After transcribing just so many documents in a day, it's a wonder I could remember my own name, never mind any of the pertinent details of each one. LOL I also kept their files on a separate backup hard drive, just in case. Ultimately, it is up to the doctor or clinic you work for. HIPAA, unfortunately, has been a bit ambiguous when it comes to what is actually required outside of hospital and clinic settings (I was a hospital transcription supervisor when this was implemented and I had to attend MANY sessions on what we had to do to comply).