Patient information & consent form

PRIVACY ACT

The Privacy Act 1998 gives you certain rights in relation to the information you give to your doctor. Your doctor requires your consent to collect personal information about yourself. Your presence here implies you consent to your doctor knowing about your health situation for this presentation and care. This form explains what your rights are over the use your doctor makes of the information and how your doctor discloses it to other allied medical professionals. Your doctor acknowledges the information he/she ask may be deeply personal, however not having it will restrict your doctor’s capacity to provide you with the standard of medical care you expect. Please read the following information carefully and then sign where indicated below. This form and the details you supply will go on your file. Please inform your doctor if there are any changes to these details.

Your doctor’s medical practice collects information for the primary purpose of providing quality health care. Your doctor requires your personal details and full medical history to properly assess, diagnose and treat your medical conditions. The information will also be used in the following ways:

• Administration of your doctor’s practice
• Billing, including compliance with Medicare and Health Insurance Commission Requirements.
• Disclosure to others involved with your health care including your treating health care professionals outside your doctor’s practice. This may involve referral\cansultation to other specialists or pathologists.
• Disclosure to others for Medical Defence purposes if necessary.
• Disclosure to locums when attached to your doctor’s practice for the purpose of continuing patient care.
• Disclosure to registrars, in a de-identified form for special or educational purposes. This involved photographic material and test results.
• Disclosure for research, medical students and quality activates to improve individual and community health care and practice management.

PATIENT CONSENT

I have read this form and understand why collecting information about me is necessary. I am also aware my doctor’s practice has a privacy policy on handling patient information. I understand that I am not obliged to provide any information requested of me. I also understand that failure to provide my doctor’s medical practice with all the information he/she needs may restrict the practice ability to provide the quality or health care and treatment I want. I consent to the handling of any information by my doctor’s practice for the purpose set out above, subject to any limitations on access or disclosure about which I notify the practice now or in the future. I acknowledge I have read this form prior to signing and that my doctor or a staff member has at my request clarified any aspect of it that I do not understand.