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PRACTICE NAME
Privacy Statement

I, _____________________________________________ understand this practice’s requirement to protect the privacy of it’s information.

All patient records including clinical data, accounts, verbal discussions, written documents including those emanating from computers or facsimile machines heard, written, received or otherwise produced by others or myself are deemed strictly private and confidential and are not to be discussed or in any way released to anyone except under instruction by the Practice Principal or designate and according to privacy law*.

I understand that a breach of this policy is grounds for immediate dismissal.

 

Staff Name ______________________________________
 

Staff Signature ___________________________________
 

Date ___________________________________________

Principal Name __________________________________
 

Principal Signature _______________________________

Date __________________________________________


 

* Commonwealth Privacy Act - Privacy Amendment (Private Sector) Act 2000
* Victorian Health Records Act 2001

Created by the Dandenong & District Division of General Practice