COVID Consent: Staff

COVID Consent: CRGW Staff

  • DD slash MM slash YYYY
  • Before considering treatment, patients must be fully informed of the risks related to COVID-19 including potential increased risk when attending clinic (particularly if they travel on public transport). Though you dont need to have read the document it is important to be aware of its existence (patients are consenting that they are aware of it before their treatments re-start). PLEASE SEE LINK AT TOP OF PAGE FOR RCOG GUIDANCE
  • I will: 1) avoid unnecessary exposure to risks of Covid-19 infection at work and in private 2) restrict interactions in line with government guidelines on social distancing and remaining at home, where appropriate 3) provide CRGW with updates regarding my health and wellbeing and whether I have infringed the code of conduct and been potentially exposed to Covid-19
  • A high temperature (fever). A new continuous cough. A loss of smell or taste (anosmia).
  • 1) Have had an organ transplant 2) Are having certain types of cancer treatment 3) Have had blood or bone marrow cancer, such as leukaemia 4) Have a severe lung condition, such as cystic fibrosis, COPD or severe asthma 5) Have a condition that makes you much more likely to get infections 6) Are taking medicine that weakens your immune system 7) Diabetic 8) Are pregnant and have a serious heart condition
  • *Shielding is when people vulnerable to COVID-19 self isolate
  • My electronic signature below confirms I have read and understand the COVID-19 specific information above.
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