0% found this document useful (0 votes)
670 views1 page

Health Facility Attestation Form

This attestation form declares that: 1) All individuals listed work at the named health facility and are eligible for the Health Emergency Allowance. 2) The submission of information through the processing system was done in accordance with relevant laws and policies. 3) All individuals provided risk exposure and personal information with the understanding it would be used to process their allowance in compliance with data privacy laws. 4) The information was provided with the expectation that government agencies would protect individual rights and data in processing personal information. 5) All information provided is true and correct to the best of the signee's knowledge.

Uploaded by

Ruffy Abdulazis
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
670 views1 page

Health Facility Attestation Form

This attestation form declares that: 1) All individuals listed work at the named health facility and are eligible for the Health Emergency Allowance. 2) The submission of information through the processing system was done in accordance with relevant laws and policies. 3) All individuals provided risk exposure and personal information with the understanding it would be used to process their allowance in compliance with data privacy laws. 4) The information was provided with the expectation that government agencies would protect individual rights and data in processing personal information. 5) All information provided is true and correct to the best of the signee's knowledge.

Uploaded by

Ruffy Abdulazis
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Attestation Form of Health Facilities

ATTESTATION FORM OF HEALTH FACILITIES

I, ___________________[Full Name of Head of Health Facility/Human Resources], ___________


[Position], a duly authorized representative of _______________, [Name of Health
Facility/MOH/CHO/PHO/CHD/MOH] do hereby declare and attest the following:

1. That all individuals listed are employed in this ________________ [Name of Health Facility] in
____________________ [Region]; are among the list of eligible health care workers and non-
health care workers to receive Health Emergency Allowance (HEA) as prescribed in the Republic
Act No. 11712 (Public Health Emergency Benefits and Allowance for Health Care Workers Act),
its implementing rules and regulations, and supplemental guidelines;

2. That this submission through the Health Emergency Allowance Processing System (HEAPS) had
been executed strictly in accordance with the provisions indicated in the aforementioned laws and
policies;

3. That all individuals listed in the COVID-19 Risk Exposure Classification (CREC) Report have
provided the information indicated therein with full knowledge that the processing thereof is
necessary for the processing of HEA, in accordance with the Republic Act No. 10173, otherwise
known as the Data Privacy Act of 2012;

4. That all individuals listed and encoded/uploaded to the HEAPS have provided the information
indicated therein with expectation that the relevant government agencies will uphold the rights of
the data subjects, implement the appropriate security measures, and will remain adherent to the
general data privacy principles of transparency, legitimate purpose, and proportionality, in
processing their personal information; and

5. That all matters set forth listed or uploaded/encoded to the HEAPS have been made in good faith,
duly verified by me and to the best of my knowledge and belief are true and correct.

Done this ___ day of _______________, 2022 in __________________

By:

……………………………

[SIGNATURE OVER FULL NAME]

[Head of Facility/Human Resources]

Common questions

Powered by AI

The form incorporates the principles of legitimate purpose and proportionality by ensuring that the data processing for the Health Emergency Allowance is conducted strictly for the intended legal and regulatory purposes under Republic Act No. 11712 and the Data Privacy Act of 2012. This means the personal information is collected and used solely to determine eligibility and distribute allowances, avoiding any unnecessary data use or collection beyond the scope of these purposes.

The attestation form references Republic Act No. 11712, known as the Public Health Emergency Benefits and Allowance for Health Care Workers Act, and Republic Act No. 10173, the Data Privacy Act of 2012. These acts and their implementing rules and regulations, along with supplemental guidelines, provide the legal framework for processing the Health Emergency Allowance (HEA) for healthcare workers.

The Head of Health Facility or Human Resources is responsible for declaring and attesting the accuracy of the information provided in the attestation form. This role is critical as it involves verifying that all individuals are eligible for the Health Emergency Allowance and ensuring that submissions to the Health Emergency Allowance Processing System (HEAPS) comply with legal requirements, thus maintaining the integrity of the allowance distribution process.

The attestation form aligns with principles of ethical governance by mandating compliance with relevant public health and data privacy laws, ensuring transparency in processes, and requiring accountable declarations from facility heads. It emphasizes actions taken in good faith and underscores the importance of upholding data privacy protections and ethical standards, reflecting a commitment to responsible oversight and management within health administrations.

The attestation form places significant emphasis on good faith by stating that the information submitted to the Health Emergency Allowance Processing System (HEAPS) must be verified and declared true by the health facility head. It obligates the attester to ensure that all data is provided honestly and with the intent of fulfilling regulatory obligations faithfully, thus reinforcing ethical standards in facility operations to maintain trust and accountability.

The form emphasizes accountability and integrity by requiring the head of the health facility or an authorized representative to declare, attest, and verify that all listed individuals are true and correct beneficiaries for the Health Emergency Allowance. The representative must confirm that all submissions through the Health Emergency Allowance Processing System (HEAPS) comply with the relevant laws and are executed in good faith.

The attestation form ensures privacy and data protection by requiring that information processing adheres to the Republic Act No. 10173, the Data Privacy Act of 2012. It states that individuals on the list have agreed to the use of their information, and it mandates that government agencies must uphold the rights of data subjects, implement appropriate security measures, and follow data privacy principles like transparency, legitimate purpose, and proportionality.

Potential challenges include ensuring accurate and comprehensive data collection to avoid errors in eligibility listings, navigating complex legal requirements, and implementing robust data protection measures to comply with the Data Privacy Act. Additionally, facilities must maintain transparency and good faith in processing, which can be difficult under pressure or with limited resources. Ensuring consistent updates and training on legal changes can also pose challenges, especially in large or under-resourced facilities.

The attestation process requires health facilities to allocate resources towards verifying and processing eligibility for the Health Emergency Allowance, potentially increasing the workload for administrative staff. It necessitates a precise and coordinated effort to gather, verify, and submit data ethically and legally, which could divert time and resources away from other critical functions, impacting overall workflow and efficiency within the facility.

Transparency is maintained by requiring the attestation form to include a declaration from the health facility's head that all individuals listed are legitimate recipients and that the information provided is truthful and verified. The form also makes it mandatory for data processing to align with the principles of transparency, ensuring that all actions taken by the facility and government agencies are clear and justifiable to stakeholders.

ATTESTATION FORM OF HEALTH FACILITIES 
I, ___________________[Full Name of Head of Health Facility/Human Resources], ________

You might also like