JCU Division of Tropical Health and Medicine_Version 2_1 September 2018
Surname Given Names
Student Number Discipline
I acknowledge that whilst I am undertaking Professional Experience Placement as part of my course I will have access to condenal and
personal informaon about paents/clients.
As a student enrolled at James Cook University I understand the obligaon of condenality of informaon concerning the personal aairs
and health related informaon of paents/clients.
I will not at any me disclose any Condenal Informaon or Personal Informaon relang to a paent/client of a placement facility that I
become aware of unless the disclosure of the informaon:
(a) is necessary to enable a health professional or me to perform health care dues; or
(b) is for the purpose of obtaining legal advice from a registered legal praconer; or
(c) is required pursuant to an order of a Court, Commission or Tribunal; or
(d) is in accordance with the Privacy Act 1988 (Cth) or the Informaon Privacy Act 2009 (Qld).
I will not disclose any private or commercial informaon (e.g. relang to other sta or the placement facility) that I become aware of
(regardless of how obtained) during a Professional Experience Placement.
I will not remove from the premises of a placement facility, any wrien or hardcopy documents/les or any electronic les, which belong
to the placement facility, and which may contain Condenal Informaon or Personal Informaon relang to a paent/client of the place-
ment facility or the operaon of the placement facility.
I will not make any record(s), (other than on documents or les which belong to the placement facility), during or aer compleon of my
Professional Experience Placement, which may idenfy any paents/clients of the placement facility. I further undertake not to remove
from the premises of the placement facility any wrien or hardcopy documents/les or any electronic les, (including notes for case stud-
ies and paent/client care plans) which I have prepared during my Professional Experience Placement and which may idenfy a paent/
client of the placement facility. I acknowledge that in order to ensure a paent/client is not idenable; I must not record any of the fol-
lowing details where the recording of one or more of the details would enable the paent/client to be idened:
(a) the name of the paent/client;
(b) inials of the paent/clients name;
(c) the paent/clients date of birth;
(d) the paent/clients date of admission or consultaon at the placement facility;
(e) any names of the paent/clients relaves;
(f) the name or details of the placement facility; or
(g) the names or details of any of the placement facilitys health professional or administrave sta.
I will not publish on social media (including Facebook, Twier, or any other social media website) any photographs, details or informaon
of any kind, which I have gained or observed during a Professional Experience Placement. I also undertake not to discuss any details or
informaon gained or observed during a Professional Experience Placement which may idenfy a paent/client of the placement facility,
at any JCU lecture or tutorial, JCU event or whilst engaging in any educaonal acvity at any place.
If I am required to access electronic health records during a Professional Experience Placement, I will not share my idencaon number
or password with any other person, and I will log o computer sessions when I am away from a workstaon.
Student Signature
Date
Condenal Informaonincludes, but is not limited to:
(a) informaon which by its very nature might be reasonably understood to be condenal or to have been disclosed in condence;
(b) informaon which a placement facility indicates is condenal;
(c) informaon which relates to any arrangements or transacons between a placement facility and its paents/clients;
(d) informaon which would be of a commercial value to a competor of a placement facility; or
(e) all records based on or incorporang informaon referred to in clauses (a) to (d).
Personal Informaonis informaon or an opinion about an idened individual, or an individual who is reasonably idenable:
(a) whether the informaon or opinion is true or not; and
(b) whether the informaon or opinion is recorded in a material form or not.
Professional Experience Placementis a clinical or praccal educaon experience, which is a required component of a course, in a health
or animal service that may be on campus or o campus. It is also known as professional pracce, work-placement, work experience, work-
integrated learning, farm work, praccum, internship, clinical experience, clinical placement, pracce placement or praccal work.
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