Hauora Hokianga (Hokianga Health)
163 Parnell Street, Rawene 0473 – Private Bag 753, Kaikohe 0440
Phone: (09)4057709 Fax: (09)4057875
My declaration of entitlement and eligibility.
I intend to use this practice as my regular and ongoing provider of general practice / GP / health care services.I understand that by enrolling with this practice I will be included in the enrolled population of this practice’s Primary HealthOrganisation (PHO)Mahitahi Hauora, and my name address and other identification details will be included on the Practice, PHOand 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 providesalong with the PHO’sname and contact details.I have read and I understandthe Use of Health Information Statement.The information I have provided on the Enrolment Formwill be used to determine eligibility to receive publicly-funded services. Information may be compared with other governmentagencies, but only when permitted under the Privacy Act.I understand that the Practice participates in a national survey about people’shealth care experience and how theiroverall careis managed. Taking part is voluntary and allresponses will be anonymous. I can decline the survey or opt out of the survey byinforming the Practice. The survey provides important information thatis used to improve health services.I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.