Cromwell Family Practice
2 McNulty Road Cromwell
P 03 4454666 F 03 4454673 EDI crfpract NZMC 21339 firstname.lastname@example.org
My declaration of entitlement and eligibility
(for public funding)
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 WellSouthPrimary Health Network, and my name address and other identification details will be included on the Practice, PHO andNational 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 PHOprovides 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 EnrolmentForm will be used to determine eligibility to receive publicly-funded services. Information may be compared with othergovernment 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 securesystem for storing electronic patient records and that all information is kept confidential and checks are in place to monitorall 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.
Your personal health information and how it is used.
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.
• 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
• 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 chargesInformation is not collected from your consultation notes (the progress notes your GP made on your file regarding your visits).
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 HealthInformation Privacy Code.
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.