RECORD OF DATA PROCESSING ACTIVITIES

Contact Details
Pharmacy Name:

Pharmacy Owner:

Pharmacy Address:

Pharmacy Phone Number:

Pharmacy Website:

Person responsible for data protection:

Purpose for Keeping Personal Data

Personal data is kept for the following purposes (tick where appropriate):
 Provision of pharmacy services
 Dispensing of medicines
 Administration of pharmacy
 Claiming reimbursement
 HR purposes
 Other: __________________________________________________________

Description of Personal Data Kept

The following personal data is kept (tick where appropriate):

 Patient Records(name, address, contact details, date of birth, gender, PPS number,
GMS/DPS/LTI number, next of kin, medication details, vaccination details, allergy details,
patient and family medical history, prescriber details, monies paid for
prescriptions/prescription levies)

 Staff Records(name, address, contact details, next of kin, date of birth, payroll number, PPS
number, salary details, pension details, bank details, absence records, holiday records,
working hours, CV/qualifications, current and previous employment details)

 Account Records(name, address, contact details, billing/payment records)

 CCTV(cameras monitoring sales floor and/or exterior of premises for security purposes)

 Other: _________________________________________________________
Recipients to whom personal data is disclosed

Patient Records Staff Records

 HSE  Payroll company
 PSI  Head office
 HPRA  Other _______________
 DAFM
 Prescribers
 Hospitals
 IT systems personnel
 Other ____________

If you disclose other personal data, describe the information and to whom it is disclosed:

Transfer of Data Outside of the EEA

Do you transfer data outside of the European Economic Area?

 Yes
 No

If yes, specify where: ____________________________________________________

General Description of Security Measures

The following safeguards are in place (tick where appropriate):

 Access to computers is restricted to authorised personnel only

 Access to computers is password protected
 Anti-virus software is in use
 A firewall is used to protect systems connected to the internet
 Computer screens are positioned out of public view
 Premises alarmed and secure when not occupied
 Manual/paper files are stored securely
 Access to CCTV is restricted to authorised personnel only
 CCTV footage is stored securely
 Other: ___________________________________________________________