Confidentiallity Sign Off (If Required)

• Site conducted

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• Employee Name

• Conducted on

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• Prepared by

Confidentiality Sign-Off

• If you have completed Part B of the New Starter Form and your job requires you to agree to the Practice confidentiality agreement the below sign-off needs to be completed.

• Employee name

• Manager Name

• In the course of your employment or associated work with the Practice, you may have access to, see or hear, confidential information concerning the medical or personal affairs of patients, staff or associated healthcare professionals. Unless acting on the instructions of an authorised officer within the practice, on no account should such information be divulged or discussed except in the performance of your normal duties. Breach of confidence, including the improper passing of registered computer data, will result in disciplinary action, which may lead to your dismissal.
  
  You should also be aware that regardless of any action taken by the Practice, a breach of confidence could result in a civil action against you for damages.
  
  
  No unauthorised use of the internet or email is allowed.
  
  Information concerning patients or staff is strictly confidential and must not be disclosed to unauthorised persons. This obligation shall continue in perpetuity.
  
  Disclosures of confidential information or disclosures of any data of a personal nature can result in prosecution for an offence under the Data Protection Act 1998 or an action for civil damages under the same Act in addition to any disciplinary action taken by Practice.
  
  
  I have read, understand and agree to the terms and conditions set out above.
  

• I have read, understand and agree to the terms and conditions set out above.<br>Please mark Yes if the above is true.

  Yes

  No

• Employee Signature of Confirmation

  Sign

• Manager Signature of Confirmation

  Sign