SLMC Health Declaration Form

St. Luke’s Medical Center ensures that our patients/ customers, guests and employees are safe from exposure to the disease. In line with this, we are requiring all persons entering the medical center premises to complete this Health Declaration form.

We shall collect your email address, name, age, gender, address, swab information, and exposure history to conduct an initial assessment of your health in relation to COVID-19 and these information will also be used for contact tracing purposes if the need arises.

All of the information that you will provide will be kept confidential and will only be disclosed to members of SLMC assigned to enforce our COVID-19 protocols and to appropriate government agencies when required for COVID-19 contact tracing.

Your data and information will be protected and secured while stored with SLMC and will be kept for 30 days from the last time of your visit.

For more information regarding your data privacy rights, you may contact the SLMC DPO at dataprivacy.GC@stlukes.com.ph / dataprivacy.QC@stlukes.com.ph or visit www.stlukes.com.ph/privacy-policy.

By continuing to accomplish this form, you hereby attest that you understand and agree with the collection and processing of your data and give your Privacy Consent. If you do not agree to any of the above, kindly close this window.