Client Consent Form

Amendments to the Privacy Act 1988 brought the introduction of the Australian Privacy Principles (APP’s), whereby replacing the previous National Privacy Principles (NPPs) from 14 March 2014. These amendments redefined how healthcare services can manage your information. OccPhyz Consulting aims to protect the privacy and secure storage of your health information at all times.

We require your personal details and full medical history so that our Doctors may accurately assess, diagnose, treat and be proactive in your health care. This includes your name, contact details, Medicare number and photographic identification.

All personal information in relation to your visit is kept safely and securely within our practice.

We require your written consent to collect personal information about you and to use this information provided in the following ways:

Billing purposes and administration purposes in the running of our practice
Disclosure to others involved in your healthcare
To comply with all legislative or regulatory requirements e.g. notifiable diseases
To send patient reminder letters/recalls/SMS messages/emails regarding your health care.

Consent for medical assessment:

I consent for my personal information being recorded in the ways listed above; and
I consent to undergo a medical examination with the Specialist Occupational Physician to whom I have been referred; and
I consent for the medical letter and or a report will be sent directly to the referrer; and
I give permission for my medical information be supplied to my Specialist if requested, in order for him/her to assess my health; and
I understand that my assessment will involve a detailed medical, work and social history and a relevant physical examination.

This means your informed consent for the sharing of information will be sought and respected in all situations unless:

we are obliged by law to disclose your information regardless of consent or otherwise;
it is unreasonable or impracticable to gain consent or consent has been refused; and
the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.
I confirm that I have read the above consent to my satisfaction.

Client First Name *

Client Surname *

Email Address *

I hereby acknowledge that I am aware of my right to access my personal information *

I hereby acknowledge that I am aware of my right to withdraw my consent at any time. *

I understand that my provider must comply with relevant privacy laws and I will contact the organisation immediately if I feel that these laws have been breached. *

I understand why certain information about me may need to be provided to other service providers in order to coordinate the best support for me *

Signature *

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Date *