MEDICAL/FIRST AID CONSENTS
(See, Leichhardt House: Code of Conduct, Section 4 and Leichhardt House: Boarding Handbook, Section 7)
Full Name of Boarder
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First Name
Middle Name
Last Name
Full Name of Parent/Carer Completing Form
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First Name
Middle Name
Last Name
Parent/carer email
*
example@example.com
Management of Confidential Medical Information
I understand that CSAA requires my child's medical information in order to be able to address any medical needs she/he experiences during her/his time in residence as a boarder at the Hostel, or when taking part in activities outside the Hostel (but where the Hostel maintains a 'duty of care'). I understand that where required to meet the immediate medical needs of my child, my child’s medical information will be shared with Queensland Health staff/other qualified medical professionals, on a need-to-know basis only. I understand the information shared may be either mandatory data (e.g. Medicare number) or sensitive information (e.g. existing medical condition) or personal information (e.g. your contact details should a Queensland Health staff member/other qualified medical professional need to talk to you. I understand that my/my child's information will be stored securely and is only accessible to the Hostel managers.
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I have read, understand and agree
I understand that as a parent/carer of a child at the hostel, it is my responsibility to keep my child's medical information accurate and to inform the hostel staff (in writing) of any relevant changes to that information (e.g. new phone number or change of Emergency Contact). I understand that incomplete or inaccurate medical information may put my child’s health at risk.
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I have read, understand and agree
Medical Consents
Consent is needed to ensure the best possible outcome for your child in the event of a medical situation during her/his time in residence as a boarder at the hostel, or when taking part in activities outside the hostel (whilst the hostel has a 'duty of care'). Where you agree, please indicate your consent for:
Hostel Staff to administer OVER-THE-COUNTER MEDICATION
Hostel Staff to administer PRESCRIPTION MEDICATION
Hostel Staff to administer EMERGENCY MEDICATION (e.g. EpiPen)
Hostel Staff to administer FIRST AID
Hostel Staff to MAKE DECISION (*If unable to contact parent/carer) with regard to administering medical treatment/first aid or referring on to Doctor or Hospital or calling an ambulance.
Hostel Staff to sign consentform for GENERAL ANAESTHETIC (*If unable to contact parent/carer)
I,
Parent Full Name
*
, give consent for Hostel staff to act as indicated above.
Signature
*
Submit Form
Submit Form
Should be Empty: