Name of Pharmacy
IG Policy: Staff Signature List
The following people from this pharmacy have seen the IG Policy and confirm here their understanding of the responsibilities they carry for the proper handling of confidential patient information.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Confidentiality Code of Conduct: Staff Signature List
The following people from this pharmacy have seen the IG Confidentiality Code of Conduct and confirm here their understanding of the responsibilities they carry for the proper handling of confidential patient information.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Data Transfer SOP: Staff Signature List
The following people from this pharmacy have read and understand the IG Data Transfer SOP.
Name in block capitals / Signature / DatePage 1 of 13
Name of Pharmacy
IG Portable Devices SOP: Staff Signature List
The following people from this pharmacy have read and understand the IG Portable Devices SOP.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Incident Management SOP: Staff Signature List
The following people from this pharmacy have read and understand the IG Incident Management SOP.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
Use of Patient Information: Staff Signature List
The following people from this pharmacy have read the Pharmacy IG Leaflet, understand how the pharmacy uses patient information and know how to discuss this with patients.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
RA01 Terms and Conditions: Staff Signature List
The following people from this pharmacy have read and understand the RA01 Terms and Conditions (NB: even those without a Smartcard should be aware of the permissible uses of a Smartcard and the security requirements around its issue and use).
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Access Control & Password Management SOP:
Staff Signature List
The following people from this pharmacy have read and understand the IG Access Control and Password Management SOP.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Business Continuity SOP: Staff Signature List
The following people from this pharmacy have read and understand the IG Business Continuity SOP.
Name in block capitals / Signature / DatePage 1 of 11
Name of Pharmacy
IG Staff Training: Staff Signature List
The following people from this pharmacy have completed the ‘Information Governance Training Booklet for Pharmacy Staff.’
Name in block capitals / Signature / DatePage 1 of 11