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    Declaration of I&C For Virtual Onsite Assessment For Observer

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    SAGAR DANI
    This document contains a declaration of impartiality, confidentiality and integrity that must be filled out by observers for a virtual onsite assessment conducted by NABH. The observer must declare that they have not provided any prior consultancy or services to the healthcare organization being assessed. They must also declare any past or family employment relationships with the organization. The observer agrees to maintain strict confidentiality of any information received during the assessment and only disclose it as required by NABH. The declaration must be signed and enclosed with the assessment report.

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    Declaration of I&C For Virtual Onsite Assessment For Observer

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    SAGAR DANI
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    This document contains a declaration of impartiality, confidentiality and integrity that must be filled out by observers for a virtual onsite assessment conducted by NABH. The observer must declare that they have not provided any prior consultancy or services to the healthcare organization being assessed. They must also declare any past or family employment relationships with the organization. The observer agrees to maintain strict confidentiality of any information received during the assessment and only disclose it as required by NABH. The declaration must be signed and enclosed with the assessment report.

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    Declaration of I&C for Virtual Onsite Assessment for Observer

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    This document contains a declaration of impartiality, confidentiality and integrity that must be filled out by observers for a virtual onsite assessment conducted by NABH. The observer must declare that they have not provided any prior consultancy or services to the healthcare organization being assessed. They must also declare any past or family employment relationships with the organization. The observer agrees to maintain strict confidentiality of any information received during the assessment and only disclose it as required by NABH. The declaration must be signed and enclosed with the assessment report.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    24 views3 pages

    Declaration of I&C For Virtual Onsite Assessment For Observer

    Uploaded by

    SAGAR DANI
    This document contains a declaration of impartiality, confidentiality and integrity that must be filled out by observers for a virtual onsite assessment conducted by NABH. The observer must declare that they have not provided any prior consultancy or services to the healthcare organization being assessed. They must also declare any past or family employment relationships with the organization. The observer agrees to maintain strict confidentiality of any information received during the assessment and only disclose it as required by NABH. The declaration must be signed and enclosed with the assessment report.

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    NABH-VA-HOPE-I&C-OBSERVER

    DECLARATION OF IMPARTIALITY,
    CONFIDENTIALITY AND
    INTEGRITY FOR VIRTUAL ONSITE
    ASSESSMENT FOR OBSERVER
    (HOPE)

    Issue No. 1 Issue Date: 07/ 20 Page 1 of 2


    Declaration of Impartiality, Confidentiality and Integrity for Virtual
    Onsite Assessment for Observer - NABH-VA-HOPE-I&C-OBSERVER

    NABH I&C-01

    DECLARATION OF IMPARTIALITY, CONFIDENTIALITY & INTEGRITY


    (to be filled in by each Observer and enclosed with the Assessment report)

    Name Assessor ID:


    (To be filled in by NABH Sect.)
    Designation

    Organization

    Address

    Capacity Observer

    Health care
    organization Assessed
    Date of visit(s)
    Type of visit Pre-assessment/ Assessment / Surveillance / Re-Assessment /
    Verification

    I ______________________________________________________________, hereby declare


    that

    i. I have not offered any consultancy, guidance, supervision or other services to the
    hospital/ HCO in any way.

    ii. I am/ am not* an ex-employee of the health care organization and am/ am not* related
    to any person of the management of the health care organization.

    iii. I will declare to the Board my and/ or my immediate family’s association with any of the
    organization that can affect the impartiality of the assessment process. I shall also
    keep the Board informed about changes in the status of my association with the
    organization before every assignment.

    iv. I got an opportunity to go through various documents of the above hospital/ SHCO and
    other related information that might have been given by NABH. I undertake to maintain
    strict confidentiality of the information acquired in course of discharge of my
    responsibility and shall not disclose to any person other than that required by NABH.
    * strike out which is not applicable

    Date:

    Place : Signature

    Issue No. 1 Issue Date: 07/ 20 Page 2 of 2


    NATIONAL ACCREDITATION BOARD FOR HOSPITALS
    & HEALTHCARE PROVIDERS (NABH)
    Quality Council of India
    5th Floor, ITPI Building; 4 A, Ring Road, IP Estate
    New Delhi - 110 002, India
    Tel/ Fax: 91-11- 42600600
    Website: www.nabh.co
    E-Mail: helpdesk@nabh.co

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