Article 5 (1) (c) of Law 44/2003, of 21 November, for the management of health professions, provides that health professionals have a duty to respect the personality, dignity and privacy of persons in their health. care, and must respect the participation of the same in making decisions that affect them.

In the same sense, Article 10 of Law 14/1986 of 25 April, in which the rights of users and Article 7.1 of Law 41/2002 of 14 November, the basic regulation of the autonomy of the patient is regulated, is also pronounced. and of rights and obligations in the field of information and clinical documentation, which provides that everyone has the right to respect the confidential nature of the data relating to his health and that no one can access them without prior authorisation under the Act.

The aforementioned legal norms translate into the health sector the regulation of the right to privacy that is also protected through other provisions of the highest rank, such as the Spanish Constitution, Law 15/1999, of 13 of December, for the protection of personal data, or the Organic Law 10/1995, of 23 November, of the Penal Code.

The particularly sensitive nature of health data and the access to intimate aspects of people by professionals and staff in the training of health institutions have determined that both the Ombudsman and the People like the different administrations integrated in the Human Resources Commission of the National Health System, provided for in article 35.3 of the Law of Cohesion and Quality of the National Health System, have promoted through a Protocol, common guidelines for action to ensure that the rights referred to above are respected in a sector of such a growing importance as is that of training and research by graduates of all levels linked to the health sciences.

The measures of this protocol are aimed both at the control of the staff in training and the researcher of the health institutions, as well as the acquisition by this collective of competencies and habits that guarantee a future professional in which respect for the privacy, dignity and confidentiality of health data are integrated and internalized in the daily work of all professionals working in areas related to the health sector.

In accordance with the provisions of article 151.2 (a) of Law 40/2015 of 1 October, of Public Sector Legal Regime and taking into account that the Human Resources Commission of the National Health System has the consideration of the Sectoral Conference, by this order the publication in the "Official Gazette of the State" of the agreement of the cited Commission of 25 October 2016 approving the said protocol is carried out

In its virtue, I have:

Order the publication, by annex to this Order, of the Agreement of the Plenary Session of the Human Resources Commission of the National Health System of 25 October 2016, which approves the protocol establishing guidelines The aim is to ensure and protect the right to privacy of the patient by students and residents in health sciences, in which paragraph 10 this publication was agreed.

Madrid, 19 January 2017. -Minister for Health, Social Services and Equality, Dolors Montserrat Montserrat.

ANNEX

Protocol determining basic guidelines to ensure and protect the patient's right to privacy by students and residents in Health Sciences

The protection of health data is a fundamental right that has been articulated through legal standards of the highest level at Community level, by Regulation (EU) 2016/679 of the European Parliament and of the Council, April 27, 2016 (which repeals the previous Directive 95 /46/EC), as at national level, through our internal legal order in which in addition to the Constitution different rules with range of law and the autonomous legislation on the It is a genuine legislative arsenal which highlights the importance of the our rule of law has the protection of privacy and personal data, especially sensitive and relevant in the field of health in which the citizen as a patient is forced to move to health information systems more data related to their privacy.

At the same time there are also several health provisions with a range of law that address the necessary availability of the health system for graduate, specialized and research teaching In the case of health sciences, it has been possible that one of the key aspects of achieving the high quality standards of our health system is to support the excellent training of health sciences. professionals.

The expansive nature of educational and health institutions accredited for teaching, has determined that in recent years there has been a substantial increase in the number of students and residents related to education. Health sciences that form or perform practices in healthcare institutions and that consequently may have contact with the patient and relatively easy access to the health data that are incorporated into a medium greatly affected by the technological evolution and globalisation.

In the face of this situation have been different institutions that like the Ombudsman or the Human Resources Commission of the National Health System (in which all the health administrations are represented) have It is considered necessary to approve the common criteria for action included in this Protocol, the ultimate aim of which is to respect the right to confidentiality of patient data and to create in students and residents habits of conduct enabling them to exercise an autonomous professional exercise in accordance with fundamental rights cited above.

For this reason, prior to the report of the Spanish Data Protection Agency (issued on 11 October 2016), the plenary session of the Human Resources Commission of the National Health System, in its session corresponding to the 25th of October 2016, has resolved to approve the protocol that is cited in the heading of this agreement in the following terms:

1. Protocol object

This protocol aims to establish basic guidelines for action aimed at guaranteeing the right to dignity and privacy of the patient when it is attended by students of qualifications related to the health sciences (students) and when they are attended by professionals who are training in health sciences (residents in training).

2. Scope of application

The guidelines for action of this protocol will apply to the health centers of the National Health System (SNS), to the private health centers and institutions that, through concert or under any of the formula of indirect management collaborate with the SNS on assistance, teaching or research, as well as other private health entities accredited for training in Health Sciences.

3. Legal framework

3.1 Article 18.1 of the Spanish Constitution that recognizes this fundamental right in the following terms:

"The right to honor, personal and family intimacy and the image itself are guaranteed."

3.2 Article 18.4 of the Spanish Constitution recognizes the right of every citizen to the control of his or her own data for use and destination in the following terms:

"The Law will limit the use of computer science (automated data processing) to guarantee the honor and personal and family intimacy of citizens and the full exercise of their rights."

3.3 Law 14/1986 of 25 April, General of Health (LGS), Article 10 of which, when regulating the rights of users, expressly refers to respect for privacy, the confidentiality of all information related to their process and the consent of the person concerned with regard to the application of teaching and research activities, rights which must in any case be compatible with the provisions of Article 104 of the Treaty, which provides for the availability of all the care structure of the health system for pre-graduated, post-graduate teaching and continued by the professionals.

3.4 The Organic Law 15/1999 of 13 December on the protection of personal data (LOPD) and its implementing regulation adopted by Royal Decree 1720/2007 of 21 December. They are general non-exclusive health care provisions that require a harmonious interpretation with the regulations mentioned in the following sections.

Article 7.3 of this law determines that " personal data referring to racial origin, health, and sexual life (are especially protected) and may only be collected, processed and transferred when by reasons of general interest as provided by a law or the person concerned expressly consents to it. "

In Article 7.6 of the LOPD, the data referred to in Article 7.3 may be processed where such treatment is necessary for the prevention or diagnosis of medical purposes, the provision of health care or medical treatment or the management of health services, provided that such data processing is carried out by a healthcare professional subject to professional secrecy or by another person subject either to an obligation the equivalent of secrecy "and the health data may also be processed," where the treatment is necessary to safeguard the vital interest of the affected person or another person, in the event that the affected person is physically or legally unfit to give his consent. "

Likewise, Article 44 of the LOPD typifies as a minor, serious or very serious infringement, the breaches arising from the duty of secrecy or the improper processing of personal data.

3.5 Law 41/2002 of November 14, basic regulation of patient autonomy and rights and obligations in the field of information and clinical documentation (LBAP). Article 7.1 of this Law states that:

"Everyone has the right to respect the confidential nature of the data relating to their health, and that no one can access them without prior authorization under the Law."

This Law is specific to the healthcare sector, so it must be easy to access and knowledge by all staff in training.

3.6 Article 199 of the Criminal Code, which refers to the duty of professional secrecy, punishes "to which I shall disclose foreign secrets, of which I am aware by reason of their trade or industrial relations".

3.7 Article 197 (1) and (2) of the Criminal Code, which punishes either "the person who discovers secrets or infringes the privacy of another without his consent" (including recordings, reproductions of listening, sound and images) and "without being authorized, it takes hold of reserved data of the personal character of another that are recorded in any type of public or private registry".

3.8 Law 44/2003 of 21 November, of management of the health professions, which in its Title II refers both to pre-graduate training and to specialist training in the field of health, regulating its essential guidelines which have was subsequently developed by the provisions referred to in paragraphs 3.9, 3.10 and by Royal Decree 639/2014 of 25 July 2014, which regulates the high quality, backbone and specific training areas, lay down the rules applicable to the annual testing of access to training places and other aspects of the health training system specialised in health sciences and certain specialist qualifications are created and modified.

3.9 Royal Decree 183/2008 of 8 February 2008 determining and classifying specialties in Health Sciences and developing certain aspects of the specialized health training system states that " Training system of residence will involve the progressive assumption of responsibilities in the field being pursued and a decreasing level of supervision, as the acquisition of the competences provided for in the programme is advanced training, to the extent of the responsibility inherent in the autonomous exercise of the Health profession of specialist ".

3.10 The Royal Decree 1146/2006, of 6 October, which regulates the special employment relationship of residence for the training of specialists in Health Sciences, by regulating the duties of residents establishes that they are (a) to provide the services and to carry out the tasks of the relevant training programme and the functional organisation of the centre in order to acquire the professional competence in the field of also contribute to the health institution's own purposes. "

3.11 Article 13.5 of the Organic Law 1/1996, of 15 January, of Legal Protection of the Child, which provides that " It shall be a requirement for access and exercise to the professions, trades and activities involving habitual contact with minors, he has not been convicted of a firm sentence for a crime against freedom and sexual indemnity, which includes sexual assault and abuse, sexual harassment, exhibitionism and sexual provocation, prostitution and sexual exploitation and corruption. children, as well as human beings. To this end, anyone seeking access to such professions, trades or activities must prove this by providing a negative certification of the Central Register of sex offenders. "

3.12 Law 33/2011, of 4 October, General of Public Health, whose articles 7 and 43.2, specifically refer to respect for dignity and personal privacy as well as the obligation to keep secret about the data it provides information systems in the field of Public Health.

3.13 The autonomic legislation dictated in this respect by the Autonomous Communities and, where appropriate, the provisions of other provisions (Law 14/2007 of Biomedical Research, Law 14/2006, of Assisted Reproduction Techniques) Human, Organic Law of the Law of the European Union, of protection of the Health and the fight against the Doping in the Sport etc.) that for its specific character it is not considered opportune to include them in a general protocol like the one that occupies us.

The standards referred to in the previous paragraphs must be known and fulfilled by the staff in training, corresponding to facilitating their compliance with the guardians and the teaching staff, without prejudice to the general duty of the supervision of the professionals of the centre with whom the staff are involved in training.

4. Right of the patient to a dignified treatment and supervised performance of the staff in training

4.1 In health care processes, people have the right to be treated in a dignified and respectful manner at all times and in any circumstances.

All people (pupils, healthcare professionals and non-healthcare professionals) who are involved in a way in a care process must respect the privacy and dignity of patients, adopting attitudes that conform to the standards of courtesy and kindness generally accepted and using appropriate language.

4.2 It will be promoted that the training staff have a behavior that corresponds to the ethical contents of the official programs of the specialty or in their case plans of study and with the deontological codes of the different health professions, as well as know the functioning of the Ethics/Research Committees, in order for the training staff to acquire skills for the decision-making guided by the ethical values.

4.3 Residents and trainees, who perform rotations or practices in healthcare facilities, will have a specialist training tutor or, with a clinical tutor, a teacher with a linked place, or a associate professor of health sciences, belonging to the staff of the health center where the clinical practices are developed. The persons referred to above shall be the reference persons to whom other professionals from the centre or persons other than the centre may be able to address, in relation to the activities they carry out and pupils in training.

4.4 Staff in training of any year, will act subject to the indications of their teaching/guardians and in the absence of these will be subject, in any case, to the indications of the specialists of the unit Without prejudice to the completion of the care delivery, please inform, even question, within the rules of healthy criticism, decisions and other aspects of the care practice.

4.5 The health centre will, as far as possible, favour the use of standardised/simulated patients/mannequins or other simulation techniques for clinical situations, in order to enable training staff to acquire clinical competencies and technical and team work skills, prior to the actual and necessary contact with the patient.

In the collaboration agreements that are signed with the educational centers, they will be expected to also carry out simulated activities in their own centers prior to the beginning of the practices in the Sanitary Center.

4.6 It is up to the management of the health centres to ensure the full integration of students and residents in training in the care dynamics of the centre, and to ensure the assumption and compliance of the regulations governing their health. operation, in particular related to its uniformity and identification, with compliance with the ethical principles and basic standards of action and with the specific guidelines contained in this protocol.

4.7 Students and residents will have a duty to integrate into the care dynamics of the center, subject to the rules governing its operation, especially the one related to its uniformity and identification, with the compliance with the ethical principles and basic standards of action and with the specific guidelines contained in this protocol.

4.8 Health institutions should inform students and residents of health sciences about measures to protect personal data when electronic devices are used (portable devices, etc.). USB sticks etc.). In no case can this information be shared using information systems and/or social networking tools/tools, which are not subject to health care facility security systems.

5. Guidelines for action in relation to the presence of PUPILS in health sciences related degrees in the care processes

5.1 Students ' consideration:

(a) University students with qualifications to enable the exercise of health professions entitled and regulated in Health Sciences: Medicine, Pharmacy, Dentistry, Nursing, Physical Therapy, Occupational Therapy, Podiology, Optica-optometry, Logopedia, Nutritionist Dietists, General Health Psychology.

b) University students of Master, Doctorate, own titles linked to health professions.

c) Professional training students in the healthcare family of both mid-grade technicians and senior-grade technicians.

d) Students of other university degrees or vocational training with periods of practice in healthcare facilities.

5.2 Patients have the right to know that there are trainees present in their care process.

The management of the Health Centre (and not the university, school or training centre of origin) will provide them with an identification card which will be placed in a visible place in the uniform containing personal data, photography and express reference to the group to which the student belongs among those referred to in point 5.1, in order to facilitate their recognition by the users and professionals of the centre.

Terminating the practice period at the center, it will be mandatory to return the identification card to the staff services of the center.

5.3 Prior to the start of the care act, the professional responsible for the act (unit specialist, guardian or resident authorized by his/her guardian) will inform the patient or his/her representative about the presence of students, requesting their verbal consent to witness the clinical performances.

In accordance with the provisions of article 7.3 of the LOPD in relation to article 8.1 of the LBAP, in the event that the patient is denied the training staff will not be present in the care process.

If the patient consents that the students are present during the clinical event, their consent will be repeated in the event that any type of physical examination, clinical procedure or any type of physical examination is considered appropriate. intervention for training purposes.

However, it will also be possible to request the patient's overall consent for a limited period of time, which will be graduated according to the planned length of stay in the health center. That period may not exceed 15 days.

The presence of students may be limited and in particular when the corresponding healthcare professional understands the student's presence in the clinical, emotional or social situation of the patient.

To consent to the presence of students and the conduct of explorations, interventions or clinical procedures by these students, consent can be granted by representation, through the persons linked to the patient for family reasons or in fact or by legal representatives, in the following cases provided for in Article 9.3 of the LBAP:

a) When the patient is not able to make decisions, at the discretion of the physician responsible for the care, or his physical or mental state does not allow him to take care of his or her situation.

b) When the patient has the modified capacity judicially and so on the sentence.

c) When the minor patient is not able to be able to understand the scope of the intervention. In this case, the consent will be given by the legal representative of the child, after having heard his opinion, in accordance with the provisions of Article 9 of the Organic Law 1/1996, of January 15, of Legal Protection of the Child.

In the case of emancipated minors or over 16 years of age who are not present in the cases (b) and (c) of the previous paragraph, consent is not to be provided by representation.

5.4 The students will be supervised at all times, unable to access the patient or the clinical information about the patient, without the direct supervision of the staff of the care center who is responsible for their training. In accordance with the provisions of Article 104 of the LGS in relation to the provisions of Royal Decree 1558/1986 of 28 June 1986 laying down the general basis for concerts between universities and health institutions, and In the case of concerts and other regional regulations, which are applicable in each case.

5.5 Except special cases allowed by the patient, during the clinical acts performed in the presence of the patient, no more than three students should be present per patient, without prejudice to the participation of others, by the consent of screens in another room. Also the sequence of repetition with different groups will be planned at reasonable times in such a way that it is not annoying or intimidating for the patient.

The maximum number of persons in physical presence before the patient shall not exceed five, counting the number of residents referred to in paragraph 6.5.

6. Guidelines for action in relation to the presence of RESIDENTS in health sciences training in the care processes

6.1 Patients have the right to know which training residents are involved in their care process and the health centre will provide them with an identification card including their first name, photograph and express reference to that it is found in any of the following assumptions:

a) Resident of any of the specialties in health sciences listed in Annex I of Royal Decree 183/2008, of February 8, indicating a degree of origin (doctor, pharmacist, nurse psychologist, biologist, chemical ....) specialty and year of residence being submitted.

b) Residents in rotation from other health centres (Article 21 Royal Decree 183/2008 of 8 February 2008).

c) Foreign healthcare professionals in an authorised training stay (Article 30 Royal Decree 183/2008 of 8 February 2008).

(d) Professional health professionals in practice in practice determined in the procedures for the recognition of Community diplomas, under the provisions of Article 10 of Royal Decree 1837/2008, of 8 May November, by which Directive 2005 /36/EC on professional qualifications is incorporated into the Spanish legal order.

(e) Health professionals in the period of professional practice in practice or in a supplementary training period determined under the provisions of Article 8 of Royal Decree 459/2010 of 16 April 2010, for which it is regulated the conditions for the recognition of professional effects on foreign degrees of health sciences specialist obtained in non-EU Member States.

6.2 Training residents will be required to present the identification card provided by the management of the centre in a visible manner, in order to facilitate their recognition by users and other professionals of the center.

Terminating the training period at the center, it will be mandatory to return the identification card to the staff services of the center.

6.3 As provided for in Article 15 Royal Decree 183/2008 of 8 February 2008, the supervision of first-year residents will be of physical presence, so health centres must ensure the existence of conditions. Organisational arrangements to ensure the supervision/visa of the actions of the R1 by the specialists of the care unit.

6.4 From the second year of training, residents will have direct access to the patient in a progressive manner and according to the instructions of their guardian to be informed to the specialists of the care unit.

In this respect in the protocols for the supervision of the services and/or the care units accredited for the training, action guidelines will be included with respect to the staff in training without prejudice to the fact that when the resident's competence for a particular performance, the "precautionary principle" is first.

The access possibilities for residents may be limited when the physician responsible for the care of terminally ill patients considers it preferable to establish a private relationship with the patient.

6.5 Except for special cases allowed by the patient and in order to preserve the patient's privacy, during the clinical acts performed in the presence of the patient, no more than three residents/patients should be present, without prejudice to the participation of others, by means of the permitted use of screens in another room. Also the sequence of repetition with different groups will be planned at reasonable times in such a way that it is not annoying or intimidating for the patient.

The maximum number of people in physical presence before the patient cannot exceed five, counting the students referred to in section 5.5.

6.6 When for reasons of vital urgency the intervention of a resident is necessary without at that time being supervised (in person or not, depending on the year of residence and circumstances of each case), forced to put on record his intervention in the medical history, giving an account of his actions to both his tutors and the specialists of the care unit in which the urgency has occurred.

7. Guarantee of access to clinical data

7.1 Access to the health service's medical history for care purposes.

7.1.1 The article 15.2 of the LBAP states that the purpose of the medical history is to " facilitate health care by placing on the record all those data which, under medical criteria, allow truthful knowledge and updated health status ".

This law in article 16.1 states that care professionals who perform the diagnosis or treatment of the patient have access to the clinical history of the patient as a fundamental instrument for their proper care, without the need for patient consent.

Therefore, the residents of any year, for being care staff and workers of the Center, have the right to access the medical history of the patients involved in the care actions they perform. at each moment. Not consulting or completing the care actions in the medical history can have an impact on the safety of patients and legal ones due to poor clinical-care praxis.

7.1.2 Those responsible for the health centre, through the administrative service responsible for managing the archive of medical records, will provide residents with access to the medical history through a mechanism of authentication (usually through a recognized identification card and electronic signature) that will be progressively implemented within six months of notification of this agreement to the Ministry of Health/Health Departments of the Autonomous communities and the National Institute of Health Management.

In accordance with the provisions of Article 16 (7) of the LBAP, the procedure used shall ensure that access to and use of the medical history is recorded.

Exceptionally those responsible for healthcare facilities will be able to establish limitations of access for healthcare professionals to medical history based on the context of attention and the policy of access to history. health centre clinic (for example in relation to gender-based violence, press policy, etc.) provided that such limitations, in accordance with the provisions of Article 76 of the LOPD in relation to the LBAP 16, are not harm care, prevention and diagnosis, or prevent the safeguarding of the vital interest of the affected.

In any case, the access authorizations shall be temporary and shall be completed by the end of the training period, at which time the health centre shall discharge the resident in the instrument providing access to the facility. the medical history.

7.1.3 In order to ensure respect for the privacy and confidentiality of health data, students will only be able to access the medical history in the terms provided for in Article 16.3 of the LBAP, which requires the Prior to the dissociation of the clinical data of the personnel, to ensure their anonymity.

Except as provided for in the preceding paragraph, those cases in which the patient himself has given his express consent so as not to alter or dissociate any data in which case it will be attached to the said medical history consent.

7.2 Access to the health service's medical history for epidemiological, public health, research, or teaching purposes.

7.2.1 The LBAP in its article 16.3 states that access to the medical history for judicial, epidemiological, public health, research or teaching purposes requires the preservation of the personal identification data of the patient, separated from those of a clinical care, so that, as a general rule, anonymity is assured, unless the patient has given his or her consent to not separate them.

Dissociation of data requires the separation of data of scientific utility (clinical-care in our case) from those others that allow to identify its holder (number of medical history, Social Security, DNI, etc.). The decoupling of data shall be carried out by a healthcare professional subject to professional secrecy or other person subject to an equivalent obligation of secrecy.

In the field of teaching, students will be able to access the medical history with dissociated personal data or clinical histories simulated by the teaching officer in order to ensure that the learning derived from them is performs respecting the privacy and confidentiality of health data.

7.2.2 The address of the Center shall authorize access to the record of the medical history. The authorisation shall be carried out by the person responsible for the registration by requiring the prior and reasoned report of the guardian or the persons responsible for the research/master/title/doctorate to be submitted for the prior opinion of the relevant Committee. Assistant Ethics/Research. Such authorization shall have the time limits that are appropriate for the particular purpose for which access is authorized.

7.2.3 Only clinical history data related to the purposes of the investigation may be used without revealing characteristics, facts, or circumstances to identify patients participating in the study. study/investigation in question.

When the publication or display of medical images or any other audiovisual media showing parts of the body from which the identity of the patient is derived is necessary, the written consent of the patient shall be required. this.

7.2.4 The activity of researchers in the field of biomedical research and clinical trials will be in line with the provisions of Law 14/2007, of July 3, of Biomedical Research, in Royal Decree 1090/2015, of 4 December, which regulates clinical trials with drugs, the Ethics Committees of Research with Drugs and the Spanish Registry of Clinical Studies, as well as in the specific regulations that will be applicable in each case.

7.2.5 Observational studies with medicinal products for human use will be guided by the SAS3470/2009 Order of 16 December, which publishes the guidelines on post-authorisation studies of an observational type for medicinal products. human use.

7.3 Access to the health service's medical history by third parties.

7.3.1 Applications for access to medical history to be made to staff in training, by patients or by third parties involved (family members, legal representative, ...) under the right of access recognised in the Article 18 of the LBAP shall be immediately transferred to the guardian or specialists of the care unit for processing as established by each institution.

7.4 Access to the SNS Digital Clinical History (HCDSNS).

7.4.1 The National Health System Digital Clinical History system (HCDSNS) allows access to certain clinical documents, generated in any SNS Health Service, ensuring that they can be consulted when Citizens require health care when travelling through the national territory.

7.4.2 Access has to be carried out exclusively for care purposes, and healthcare professionals with care functions that have previously been authorized by their health service can access the system.

7.4.3 Students of health sciences-related degrees cannot therefore be accessed.

7.5 Copies.

Without prejudice to the timely access to medical history as provided for in paragraphs 7.1.1 and 7.1.3, the training staff is either resident or student, may not make copies of the information contained in the medical history. by no means and in any form, except written consent of the patient or in the case of anonymised medical records with express permission of the person responsible for the registration of medical records on the proposal of his/her tutor/teacher.

8. Patients ' right to the confidentiality of their health data

8.1 Article 7.1 of the LBAP states that " any person has the right to respect the confidential nature of the data relating to his health and that no one can access them without prior authorization to the Law. "

This right is translated into the duty of confidentiality/secrecy provided for in Article 2.7 of that law which states that " the person who produces or has access to the information and the clinical documentation is obliged to keep the reserve due ".

8.2 Both residents and students are subject to the duty of confidentiality/secrecy, not only during the stay in the health center in which they are being formed, but also after it has been completed, without this duty being extinga by the patient's death.

The duty of confidentiality affects not only "intimate data" (including psychological ones related to ideas, values, beliefs, personal experiences ...) but also to biographical data of the patient and his/her environment (whether intimate or not) whose knowledge by third parties may affect the rights of the person under treatment.

The duty of confidentiality/secrecy not only refers to the data contained in the patient's medical history but also to those who have been accessed by verbal communication, recordings, videos, as well as the contents of the contents. in any type of computer, electronic, telematic or public or private registers, including those relating to the degree of disability and genetic information.

The duty of secrecy is without prejudice to the legal cases in which its maintenance involves risk to the life of the affected person or third parties or to the detriment of the Public Health, in which case it will be brought to the attention of the Care responsible for the relevant service/unit of care to be acted upon.

8.3 To this end all staff in training will subscribe to the start of their stay in the health centre, where they are being formed, a commitment of confidentiality (see indicative model in Annexes I and II) which will be included in the Registration for the research and training staff referred to in paragraph 9, and in the case of training specialists in the personal files held by the Teaching Commission.

9. Final provisions

9.1 Registration of students with qualifications related to health sciences.

9.1.1 All the educational institutions with which the health centres have subscribed under the applicable law, collaboration agreements/concerts for the teaching/research, facilitating the realization of In the case of students, they must submit to the Management of the Centre, prior to the beginning of each academic year, a personalized relationship between the students of each course who will carry out their training, with an express indication of the the degree to which they are being trained, of the teachers referred to in paragraph 3.4, as the calendar and care units involved in the implementation of the practices.

9.1.2 The staff services of the health institutions or the organ that determines the management of the health institutions, will have a "book of students in training/research staff" that will meet the requirements set in LOPD for creating files that contain personal data. The above mentioned data and the annotation on which the individual commitment of confidentiality has been subscribed shall be returned annually.

This book, in digital format, will be accessible from any care service that wants to see that the student is authorized to remain in the center and service in question.

9.1.3 It will not be necessary to register in this book the specialists in training for the residence system, whose control, being linked by a labor contract with the corresponding entity of the corresponding The Centre shall be carried out by the staff of the Institution responsible for the payment of their remuneration and by the Teaching Commissions to which the accredited teaching units in which the resident is being trained are attached.

10. Spreading this protocol

10.1 This protocol has been approved by the Human Resources Commission of the National Health System and will be published in the BOE.

10.2 This protocol will be transferred to the health training bodies of the Health/Health Ministry of Autonomous Communities and the National Institute of Health Management for their transfer to the Management of health centres, to the Joint Committees referred to in Article 4. Second point 3 of Royal Decree 1558/1986 of 28 June, and the Commissions of Teaching.

10.3 This protocol will be delivered to staff in training in healthcare facilities at the time of their incorporation.

10.4 It is recommended that in the information session that prior to incorporation be carried out by the health center, the aspects indicated in this document are treated, among others.

10.5 Furthermore, this protocol will be included on the website of the Ministry of Health, Social Services and Equality.

11. Monitoring

Within one year, the Health/Health Department of the CCAA and the National Institute of Health Management will report to the Human Resources Commission of the National Health System on the implementation and enforcement of the forecasts contained in this Protocol.