ࡱ> -/,c  bjbjԚ *Z\Z\ .....BBBB NBrbbbbb===JLLLLLL$=p.)==))p..bbuuu) .b.bJu)Juubp%Fv3"60U.4="_uw===ppk ===))))=========> : Department of General Practice Queens University Ƶ Patient Consent to Video Recording for Undergraduate Medical Teaching Date . Patients name Dr ., whom you are seeing today is hoping to video 4th year undergraduate students consulting with patients. The purpose is to enable students to improve their communication and clinical skills. The tape will be played back to the student with 2-3 other students who are part of the teaching session and will be interviewing other patients. The tape will be erased at the end of this teaching session. The video is ONLY of you and the doctor or medical student talking together. The camera will be switched off at any time if you wish. All video recordings are carried out according to guidelines issued by the General Medical Council. You do not have to agree to your consultation with the doctor being recorded. If you do not want your consultation to be recorded, please tell the doctor. This is not a problem, and will not affect your consultation in any way. To be completed by the Patient I have read and understood the above information and give my permission for my consultation to be video recorded. . Date Signature of the patient BEFORE THE CONSULTATION After seeing the doctor I am still willing for the recording of this consultation to be used in this teaching session. . Date Signature of the patient AFTER THE CONSULTATION To be filed in the Patients Notes <=/ 3 R   Ϻꤟ hz >*hz >*CJOJQJhz 5CJOJQJhz CJOJQJhz CJH*OJQJhz CJOJQJhz OJQJhz >*OJQJhz 5CJOJQJhz 5>*OJQJ<=e^ J 2 3 R S #$d%d&d'dNOPQ&$$d%d&d'dNOPQa$ & Fh^h`$a$$a$$a$    $a$#$d%d&d'dNOPQ (/ =!"#*$% s2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH 8`8 Normal_HmH sH tH @@@  Heading 1$@& CJOJQJD@D  Heading 2$@&5CJOJQJJJ  Heading 3$$@&a$5CJOJQJD@D  Heading 4$@&5CJOJQJF@F  Heading 5$$@&a$ CJOJQJF@F  Heading 6$@&5>*CJOJQJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]    8@0(  B S  ?,M,M44 ;; B*urn:schemas-microsoft-com:office:smarttagscountry-region8*urn:schemas-microsoft-com:office:smarttagsCity   337   ~ir&(h^`(CJOJQJo(q~^F%QW@P:z ]  @QQQQ @UnknownG*Ax Times New Roman5Symbol3. *Cx Arial=Calisto MT;WingdingsA$BCambria Math"hqqjf% % !24+3HP?z 2!xx :Department of General Practice  Queen s Unversity BelfastDept of General Practice Louise Sands Oh+'0 ( @L l x  <Department of General Practice Queens Unversity ƵDept of General PracticeNormalLouise Sands2Microsoft Office Word@F#@.{z@NqAv@NqAv%՜.+,0$ hp|     ;Department of General Practice Queens Unversity Ƶ Title  !"#%&'()*+.Root Entry Fp%Fv01Table WordDocument*SummaryInformation(DocumentSummaryInformation8$CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q