• Enrolment Form

  • Hauora Hokianga (Hokianga Health)

    163 Parnell Street, Rawene 0473 – Private Bag 753, Kaikohe 0440

    Phone: (09)4057709 Fax: (09)4057875

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  • My declaration of entitlement and eligibility.

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  • 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 Health
    Organisation (PHO)Mahitahi Hauora, 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’sname and contact details.
    I have read and I understandthe 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 participates in a national survey about people’shealth care experience and how theiroverall care
    is managed. Taking part is voluntary and allresponses will be anonymous. I can decline the survey or opt out of the survey by
    informing 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.

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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 chargesInformation 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 HealthInformation 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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