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Brighton Health and Wellbeing Centre

18-19 Western Road



Telephone: 01273 772020

Declaration Of Confidentiality

Name:            _____________________________

Designation:   BHWC Covid vaccination Volunteer

I understand that during the course of my duties I may have access to personal information about patients, personal information about members of staff and sensitive information about the Practice.

I understand that I should only enter the patient record when necessary with reference to patient care and with the permission of the patient or their advocate.  Entering the record for any other purpose is an act of gross misconduct which could result in instant dismissal/

I declare that I will respect the confidentiality of all such information now and forever.

I understand the disclosure of confidential information to unauthorised persons may lead to legal action.



Employees signature:               ________________________­­­­­­­­­

Designation:                            ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­BHWC Covid vaccination volunteer


Date:                                           __________________________

Signature on behalf of practice: __________________________

Designation:                               __________________________

Date:                                           __________________________