• Enrolment Form

  • Cromwell Family Practice

    2 McNulty Road Cromwell

    P 03 4454666 F 03 4454673  EDI crfpract  info@cromwellfamilypractice.co.nz

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  • My declaration of entitlement and eligibility

    (for public funding)

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  • My Agreement to the enrolment process

    I intend to use this practice as my regular and on-going provider of general practice / GP / health care services.
    I understand that by enrolling with Cromwell Family Practice, I will be included in the enrolled population of WellSouth
    Primary Health Network, and my name address and other identification details will be included on the Practice, PHO and
    National Enrolment Service Registers.
    I understand that if I visit another health care 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 and the services this practice and PHO
    provides along with the PHO’s name and contact details.
    I have read and I agree with the Use of Health Information Statement. The information I have provided on the Enrolment
    Form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other
    government agencies, but only when permitted under the Privacy Act.
    I understand that the practice may share my health information between healthcare providers using HealthOne, a secure
    system for storing electronic patient records and that all information is kept confidential and checks are in place to monitor
    all access.
    I understand that further information on HealthOne is available from the practice on request.
    I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.

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  • Health Information Privacy statement

    Your personal health information and how it is used.

    CONSENT TO COLLECT PATIENT HEALTH INFORMATION

    Patients directly consent to health information (patient data) being collected when they sign an enrolment form with their family doctor or visit a GP practice.
    Your health information will be shared with others involved in your healthcare.
    This helps to improve care for individuals, and with the health information from many people collected together it can be used to improve health services, care for other patients and future generations as well as community wellbeing.

    Patient data is used for the following reasons:

    • To measure and improve the quality of healthcare
    • To understand the frequency and severity of common major health problems
    • To ensure that the differences in health status between different population groups are reduced
    • To identify health prevention and promotion strategies
    • To advocate for changes and improvement to health care funding and delivery
    • To support some health research, subject to approval by an ethics committee
    • To meet contract requirements with the Ministry of Health needed to obtain funding to reduce the cost of your GP visits

    WHAT INFORMATION IS COLLECTED?

    • Information about you (name, date of birth, gender, address, ethnicity, citizenship, NHI number)
    • Information about your health and your medical conditions and measurements
    • Information about health services that are being provided to you e.g. medications, immunisations, health screening, lab results
    • Information about the financial transactions around consultation charges
    Information is not collected from your consultation notes (the progress notes your GP made on your file regarding your visits).

    SECURITY & PRIVACY OF PATIENT DATA

    ProCare is a Primary Health Organisation (PHO). Patient data is sent securely to the PHO which stores this information in a data warehouse. The data provides a single source of information for practice clinicians. It is able to produce reports that help manage and improve services for patients.
    Some health information we collect and generate is stored electronically by cloud service providers located in Australia. This information may also be processed (but not stored) on cloud servers located in other overseas countries. This information is encrypted at all times and these providers comply with internationally recognised security standards.
    Information is also sent to the Ministry of Health to allocate funding subsidies which reduce the cost of GP visits.
    Robust protocols and processes have been developed for collecting and storing this data to make sure it is kept safe and protected.
    Our processes are fully compliant with the Privacy Act 1993 and Health
    Information Privacy Code.

    CONSENT OPTIONS

    If you do not consent to health information such as medical conditions, medications and lab results being collected, then you may ‘opt-off’ by letting your practice know.

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