Patient Contact Details

Patient Medicare & Insurance Details

Patient Medical History

Privacy Policy

This medical practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and a full medical history so that we may properly assess, diagnose, treat and be proactive in your health care needs. This means we will use the information you provide in the following way:

• 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 specialists outside this medical practice. This may occur through referral to other doctors, or for medical tests and in the reports or results returned to us following the referrals.

• Details of your name, address and phone number may be passed onto debt collection agencies if necessary to recover outstanding dues.

On occasions the practice undertakes training of students, or research activities. In these instances:

Disclosure to other doctors in the practice, locums and by Registrars attached to the practice for the purpose of patient care and teaching. Please let us know if you do not want your records accessed for these purposes, and we will note your record accordingly.

As part of this practice’s commitment to improve the quality of care the practice audits the treatment and outcomes of the care delivered to its patients. This usually involves all components of care for a particular disease, including that by other practitioners and institutions. When required, care plans are discussed with other doctors and health care professionals in a multidisciplinary meeting to ensure a coordinated approach. If you do not wish your care to be audited or discussed at multidisciplinary meetings please advise your doctor.

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 have read the information above and understand the reasons why my information must 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 that my failure to do so might compromise the quality of the health care and treatment given to me.

I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.

I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.

I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify this practice of. 

I consent to the collection of my information from x-ray, pathology, MRI, medical records from the hospitals, and other people who have been involved in my medical care.