Parent or Caregiver to sign if you are under 16 years（如果您未满16岁，需父母或监护人签字）

I intend to use this practice as my regular and on-going provider of general practice / GP / health care services.我选择此家庭医生诊所作为我的医疗提供者/家庭医生/基本卫生保健服务I understand that by enrolling with this practice, I will be included in the enrolled population with the Primary Health Organisation (PHO) this practice belongs to, and my name address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers.我明白在此诊所注册的同时我也将在诊所归属的基本卫生保健服务机构注册，我的名字，地址及其它身份证明将被保留在此诊所和此机构。I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.我明白如果我去除此诊所以外的其它诊所，我可能会被要求支付更高的诊费。I have been given information about the benefits and implications of enrolment and the services this practice and PHO provides along with the PHO's name and contact details. 我已获得有关注册的好处和影响的信息，以及悅生诊所和它所属的基本卫生保健服务机构的名称,联系方式和所提供的服务。I understand the Practice participates in a national survey about people’s health care experience and how their overall care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the survey by informing the Practice. The survey provides important information that is used to improve health services. 我了解悅生诊所参与了一项关于人们的医疗保健经验以及如何管理他们的整体护理的全国调查。参与是自愿的，所有回复都是匿名的。我可以拒绝调查或选择退出调查。该调查提供了用于改善卫生服务的重要信息。I agree to the practice sharing my health information with other health providers involved in my health care. 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. 我同意悅生诊所向其他医疗保健提供者分享我的健康信息。我在报名表上提供的信息将用于确定获得公共资助服务的资格。信息可能会与其他政府机构进行比较，但只有在《隐私法》允许的情况下。I also agree to my information being used for practice quality/audit activities and to being included in the practice screening, recall and health programs. 我也同意将我的信息用于质量审核活动，并同意将其包含在筛查、召回和健康计划中。I have been informed of the Health Information Privacy statement posters. 我已经得到关于健康信息隐私权声明的信息。