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Include details of staff involved and any contributing factors) Incident Classification: (see incident management procedure for guidance) Brief description of action already taken Actions taken to prevent a reoccurrence Has the IG Lead been informed Yes No Has the PCT been informed Yes No Have you contacted your insurers Yes No Has the ICO been informed Yes No Details of any advice provided to pharmacy Reporter details Name Job title ( ) Information Governance Lead follow up (investigations, findings and planned actions) IG Lead Name: Date.