February 2013
Integrating Mental and Physical healthcare: Research Training and Services
(IMPARTS)
Audit Data Transfer and Confidentiality Agreement
Identifiable IMPARTS datasets may be transferred by from the IMPARTS Project Team to
clinicians working in the clinical services where IMPARTS is implemented.
These data are for clinical audit and monitoring purposes only and must not be used for
research. There is a separate research approval process which must be used for all research
projects.
Access to identifiable patient data will only be granted to clinicians who already have access
to identifiable IMPARTS data via the Electronic Patient Record (EPR). Clinicians will only be
permitted access to the data of patients for whom they provide care.
This agreement is between the IMPARTS project on behalf of KING’S COLLEGE HOSPITAL
NHS FOUNDATION TRUST/GUY’S AND ST THOMAS’ FOUNDATION TRUST and
NAME/INSTITUTE. It refers to the identifiable dataset provided by the IMPARTS project to
NAME on DATE for the purposes of clinical audit and monitoring.
I, the undersigned, understand that the data are for clinical audit and monitoring purposes
only and must not be used for research.
I agree that I will not pass the on the data to a third party.
I confirm that I will return all copies of the dataset along with all documents (electronic and
paper) relating to the dataset immediately upon request.
I agree to hold the data confidentially and securely in accordance with Trust policies.
Signed by NAME
Signed on behalf of the IMPARTS Project
Signed _______________________________
Signed ______________________________
Name ________________________________
Name ______________________________
Date _________________________________
Position _____________________________
Date _______________________________