We require your consent to collect personal information about you. Please read this information carefully and sign where indicated below. This Medical Practice collects information from you for the purpose of providing quality health care. We require you to provide us with your personal details and a full medical history so we may properly access, diagnose, treat and be pro-active in your health care needs. This means we will use the information you provide in the following ways.
- Administrative purposes in running our medical practice.
- Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.
- Disclosure to others involved in your health care, including treating doctors and other specialists outside the practice. This may occur through referral to other doctors or for medical tests and in the reports or results returned to us following referrals.
Please let us know if you do not want your records accessed for these purposes and we will note your records accordingly.
I have read the above and understand the reasons why my details should be collected. I am also aware that this practice has a Privacy Policy on handling patient information. I understand that I am not obliged to provide any information requested of me, but failure to do so might comprise the quality of health care and treatment given to me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances. I understand I may be contacted by general mail-outs/specific recalls from the Practice with regards to my continuing health management.
