Forms

NG Gynehealth respects your rights to privacy and takes our privacy obligations seriously. We comply with the Australian Privacy Principles, found under the Privacy Act 1988 (Cth). Our Privacy Policy can be obtained at reception, or from our website at nggynehealth.com.au

We require your consent to collect personal information and health information about you. Please read this information carefully, and sign where indicated below.

We collect information from you for the primary purpose of providing you healthcare services. We require you to provide us with your personal and health information including your full medical history so that we may provide our services to you. We will also use the information you provide in the following ways:

• appropriately manage our practice, such as conducting audits and undertaking accreditation processes, manage billings and training staff;

• effectively communicate with third parties, including the Medicare Australia, private health insurers, government departments and other practitioners involved in your healthcare;

Your privacy is a high priority. This is even more relevant given that we live in a small town and deal with sensitive issues. In order to provide contemporary patient care with effective and timely communication, your information will be accessed by the team dealing with your care. This includes doctors, midwives, nurses and admin staff. If you have any specific concerns regarding your privacy, please contact our practice manager or speak with your doctor.

I have read the information above and understand why my information is collected and how it is used. I acknowledge that I am not obliged to provide any information requested of me, but that failure to do so might compromise the quality of care provided to me. I consent to the collection of my personal and health information.

While e-communication tools including, but not limited to email, SMS and voicemail are increasingly becoming the norm and expectations in the modern world, there remain certain considerations that we would like our patients to be aware of. While the practice takes all reasonable contemporary measures for privacy and security, there remains a fine balance between the convenience of the use of technological tools and its perils.

I understand it is my responsibility to contact the clinic for results.

3. Consent Release — I consent for NG Gynehealth to discuss my condition and results with the person/s named below. I am aware these might include sensitive information such as semen analysis, infection screening, etc.

Privacy of our patients remains a high priority for our practice. This is even more relevant given that we live in a small town and deal with sensitive issues, while our staff are all subject to the Privacy Act 1988, our practice has a robust privacy policy. In order to provide contemporary patient care with effective and timely communication, your information will be accessed by the team dealing with your care. This includes doctors, midwives, nurses and admin staff.

If you have any specific concerns regarding your privacy, please contact our practice manager.