The law gives you certain privacy rights in relation to information that you give to this medical practice. We need your consent to collect personal information about you/your child. The fact that you have come here implies that you consent to us knowing about your/your child’s health situation either for a particular event or generally. This form explains what your rights are over the use of the information and how we may disclose it to other medical service providers.
The information we may ask you to give us is deeply personal. But not having it will restrict our capacity to provide you with the standard of medical care that you expect.
Please carefully read the following information about privacy issues. It will go on your/your child’s file and you may examine it or change it at any time.
The main reason we collect information from you/your child is so we can assess, diagnose and treat your/your child’s illness/es properly and be pro-active in your/their health care. We will also use the information you provide in the following ways:
- Administration of this medical practice.
- Billing, including compliance with Medicare and Health Insurance Commission requirements.
- Disclosure to others involved in your/your child’s health care, including doctors and specialists outside this practice who may become involved in treating you/your child. This may occur through referral to other doctors, or for medical tests and in the reports or results returned to us following the referrals. If necessary, we will discuss this with you.
- Disclosure to others for medical defence purposes if necessary.
- Disclosure to other doctors in the practice, locums and registrars attached to the practice for the purpose of patient care and teaching. Please let us know if you do not want your/your child’s records accessed for these purposes, and we will note the record accordingly.
- Disclosure for research and quality assurance activities to improve individual and community health care and practice management. You will be informed when such activities are being conducted and given the opportunity to “opt out” of any involvement.
I understand that I am not obliged to provide any information requested of me/my child. I also understand that failure to provide this medical practice with all the information it needs may restrict the practice’s ability to provide the quality of health care and treatment that I want for myself/my child.
I am aware that I have the right to access the information collected about me/my child, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.
I understand that I may request an amendment to my/my child’s personal information if it is incorrect. I will be provided with a written reason if a request for amendment is denied.
I understand that if my/my child’s information is to be used for any other purposes other than set out above, my further consent will be obtained.
I consent to the handling of my/my child’s information by this practice for the purposes set out above, subject to any limitations on access or disclosure about which I notify this practice now or at any future time.
I understand that I have the right to lodge a complaint about the handling of my personal information if I am dissatisfied, which will be dealt with in accordance with this practice’s complaint handling procedure.
I acknowledge that I have read this form before signing it and that a member of the staff of this practice has, at my request, clarified any aspects of it that I did not at first understand.