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Brooklane Medical Centre We put your needs first! BROOKLANE MEDICAL CENTRE 33 Brooklane Avenue Ottawa, ON K2B 6M7 (613) 224-2308 CONFIDENTIALITY AGREEMENT 1, Name of Student, an employee of Brooklane Medical Centre (BMC), will comply with the Freedom of Information and Protection of Privacy Act (FIPPA) privacy module. I understand that I may encounter protected health information during my employment with BMC through access and/or availability and that it is my responsibility to maintain confidentiality of this information to the highest standard. I further understand that any breach of confidentiality would result in disciplinary action against me, possible termination of employment, and possible legal action against BMC. Name of Student Signature September xx, 2021 Date Name of Student Printed Name Lynn Berry Witness September 22, 2021 Date