Residential Medication Management Review (RMMR) Patient Consent Form

What is an RMMR?

A Residential Medication Management Review (RMMR) is a service provided to an eligible Patient residing in an eligible Australian Government-funded Residential Care Facility with the intended purpose of identifying, resolving, and preventing medication-related problems.

A Pharmacist accredited to provide RMMR services will conduct a RMMR for a Patient when requested to do so by the Patient’s Referring Medical Practitioner. This review will be conducted in collaboration with the Patient’s Referring Medical Practitioner and appropriate members of their healthcare team.

The RMMR consists of a comprehensive assessment of the Patient’s medications and medication-related healthcare interventions.

For more information, refer to the Pharmacy Programs Administrator (PPA) website.

 

Why am I being asked to complete this form?

In order to provide this service, the Service Provider (the Pharmacist providing this service) is collecting and using personal information about the Patient in order to determine their eligibility, and if eligible, provide a service under the Seventh Community Pharmacy Agreement. The Service Provider may also collect the Patient's personal information from their Community Pharmacy.

The Service Provider can be contacted using the details below:

Please note that once the service has been completed, the date and time of service completion will be listed on the completed form. 

Disclosure

The Service Provider will disclose your personal information such as your Medicare Number, name and date of birth to the Pharmacy Programs Administrator and the Australian Government. The Service Provider may also disclose your personal information to your Community Pharmacy, other members of your healthcare team and another Service Provider as a requirement of conducting the service. The Pharmacy Programs Administrator has a privacy policy that you can read at www.ppaonline.com.au. You can also obtain a copy of the privacy policy by contacting the Pharmacy Programs Administrator using the contact details on the website above. The privacy policy contains information about:

• How you may access the personal information that the Service Provider, the Pharmacy Programs Administrator or the Australian Government holds about you and how you can seek to correct it
• How you may complain about a breach of the Australian Privacy Principles. 

The Australian Government is unlikely to disclose your personal information to overseas recipients. If you do not wish to provide all of the personal information or consent to collect and disclose the personal information required, the Service Provider will not provide you with the service.

Written Patient Consent

This may be filled in by the patient / individual who has the legal authority to consent and sign on the patient's behalf (for example, a guardian, a person appointed under an enduring power of attorney or a person otherwise authorised to give this consent in your State or Territory) and physically handed to the Service Provider or electronically sent to the Service Provider. I consent to the Service Provider (including all accredited and registered pharmacists undertaking the service on behalf of the Service Provider) collecting and disclosing personal information for the purpose indicated above for: