18 Limerick Street, 9320 Alexandra

Ph: 03/901 6277 

My declaration of entitlement and eligibility

(for public funding)

Enrollment

I understand that by enrolling with this practice I will be enrolled with the PHO -Primary Health Organisation (Wellsouth). My name, address and other identification details will be included on both the practice and PHO enrolment registers.

I understand that if I visit another provider where I am not enrolled, I may be charged a higher fee. 

I have been given information about the benefits and implications of enrolment with the PHO and their contact details. 

I have read and I agree with the Health Information Privacy statement (below). 

I agree to inform the practice of any change in my eligibility. 

I understand that the practice uses AI software to summarise notes for their consultations and phone calls.

I understand that the practice does not have running accounts and that any consultation or service is payable on the day or at the time of service. Should I fail to settle my account timeously, this could result in limited care until the issue has been resolved with additional administration cost applied to my account.

Health Information Privacy Statement

Access to Your Health Information

You have the right to access and request correction of your health information under Rules 6 and 7 of the Health Information Privacy Code 2020.

Collection of Health Information

By accepting health care services from this practice, you agree that we may collect information about you from other agencies for the purpose of maintaining an up-to-date health record and providing safe and quality care.

This may include:

From other health providers and shared health records:

Laboratory, radiology, and other diagnostic results
Access to authorised national or regional health information systems to support your care (including medical history, test results, and prescribing information)
Correspondence from hospitals, emergency departments, after-hours providers, specialists, and allied health providers (including discharge summaries and specialist letters)
Communication with hospitals or specialists to follow up referrals or seek advice, where this results in information being shared.
Information from screening programmes (e.g., breast, bowel, cervical screening), including results and attendance notifications.
From non-health agencies and organisations:

Police, legal representatives, Oranga Tamariki, insurance companies, Ministry of Social Development (Work and Income New Zealand), and the Accident Compensation Corporation
Employers (e.g., fitness for work information)
New Zealand Police (e.g., firearms licensing information)

Use and Sharing of Health Information

Your health information will be:

Held securely by the practice.
Used to provide appropriate care and maintain accurate health records.
Shared with other health professionals directly involved in your care where necessary.
Information you provide may also be:

Used by the Ministry of Health to assign or update your National Health Index (NHI) number.
Shared with your Primary Health Organisation (PHO) and the Ministry of Health to obtain subsidised funding on your behalf.
Used to determine eligibility for publicly funded services (and may be compared with other government agencies where permitted by law)

Health Programmes, Planning, and Research

Relevant health information may be shared with PHOs or external agencies for programmes you are enrolled in (e.g., immunisation, screening, diabetes care).

De-identified health information (which will not include your name) may be used by health agencies such as Health New Zealand, the Ministry of Health, or PHOs for:

Health service planning and reporting
Monitoring service quality
Payment

Your information may also be used for approved health research, but only where it will not identify you and has been approved by an ethics committee.

Other Disclosures

We may disclose relevant health information:

If you visit another GP, with your consent (or as permitted for subsidy claims, where only limited information is shared)
During financial or clinical audits, in accordance with applicable legislation
To regulators, insurers, indemnity providers, or legal advisers if concerns or complaints are raised about your care.
Except as outlined above, your health information will remain confidential within the practice unless you give specific consent.

Audit and Verification

In the case of financial audits, authorised auditors may review relevant records to verify claims. Where health matters are involved, review will be conducted by appropriately qualified healthcare professionals. Auditors may contact you to confirm services were received.

Your Care Team

Members of your healthcare team may add to and use your health record to ensure you receive safe, coordinated, and appropriate care.

Enrolment Information

Information provided during enrolment will be:

Held by the practice.
Shared with the Ministry of Health and PHO for identification, funding, and service eligibility purposes.

Complaints

If concerns are raised about the services we provide, relevant health information may be shared with appropriate organisations to investigate and respond.

Confidentiality

Your health information will remain confidential and will not be disclosed outside the practice except as described above or where required or permitted by law.