ENROLMENT FORM

● 8D Tamariki Avenue, Orewa 0931 ● Phone: 09 426 5437 ● Fax: 09 427 8410 ● EDI: markjohn ●

My declaration of entitlement and eligibility:

Please upload a clear photo of your identifcation (example below)

Enrolment

I understand that by enrolling with this practice I will be enrolled with the PHO - Primary Health Organisation (Procare). 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. 

Terms of trade

By enrolling with the Orewa Medical Centre, I agree to pay for all consultation and service costs at the time of my appointment or request for service.

I understand that any outstanding accounts at the end of any given month will incur an additional $10.00 administration fee for each month the account is overdue unless, I have made a prior arrangement with the accounts manager that is agreed to by both parties.

If unpaid after 3 months, my account may be placed in the hands of a debt collection agency and all costs associated with this will be my responsibility to pay.

We frequently update our Facebook and Instagram page with improtant information, so click on the links below to be in the know! 

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

A PHO is a Primary Health Organisation. 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.