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CONTINENCE ASSESSMENT REFERRAL AND SERVICE AGREEMENT

CONTINENCE ASSESSMENT REFERRAL AND SERVICE AGREEMENT

PROVIDED BY: STACEY DUBBERLEY - NURSE CONTINENCE SPECIALIST
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    PLEASE BE AWARE THAT WE ARE UNABLE TO PROVIDE SERVICE TO AGENCY MANAGED CLIENTS
    • Self Managed
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    Your Rights & Responsibilities:

    • I acknowledge that I have read and understand all relevant terms and conditions.
    • The signing authority acknowledges responsibility for ensuring payment of service invoice/s
    • The Nurse Continence Specialist will provide continence assessment to me via Telehealth. The Nurse Continence Specialist will provide an appropriate outcome report +/- assistive technology quotation to me after full payment of services is received.
    • I have the right to request access to my information held on file by the Nurse Continence Specialist for the purposes of correction, clarification and addition of further details relevant to assessment.
    • It is my responsibility or my authorised nominee, to provide the Nurse Continence Specialist with any revocation of this consent as soon as possible, where applicable, in writing.

    Rights & Responsibilities of the Nurse Continence Specialist:

    • The Nurse Continence Specialist may collect, use, disclose, store and handle personal information about me for the primary purpose of providing services to me, managing the supply of these services, and, where necessary sharing it with other health service providers and health professionals, who may be able to further assist me, in accordance with the Information Privacy Act 2000 (IP Act) and the Health Records Act 2001 (HR Act)

    Cancellation Policy:

    • Failure to attend a scheduled telehealth appointment or cancellation with less than two (2) CLEAR BUSINESS DAYS notice may incur a fee 50% of the expected scheduled NDIS fee as per current NDIS Guidelines.
    • If am more than 15 minutes late to a scheduled telehealth appointment, it may be cancelled and the cancellation policy will apply and fees charged, unless otherwise arranged.
    • All prices quoted may change from time to time, without notice, in keeping with NDIS price guides. All feedback, compliments or complaints are encouraged by emailing ndisnursecontinencespecialist@gmail.com

    NDIS Pricing Arrangements and Price Limits 2024-2025 Effective 01/07/2024

    • Disability-Related Health Supports Core – Assistance with Daily Life or Capacity Building – Improved Daily Living 
    • Continence: for participants who need daily assistance with toileting (bladder and bowel)
    • Continence Assessment, Report & Prescription hours Item Number 01_618_0114_1_1 or 15_418_0114_1_3 Delivery of Health Supports by a Clinical Nurse Consultant Weekday $163.91 per hour totalling $655.64 (GST not applicable)
    • Home visit (if applicable) $1.00 per kilometre travelled Item Number 01_799_0114_1_1 and $2.73 per minute travelled Item Number 01_618_0114_1_1 or 15_418_0114_1_3 to & from Napoleons, VIC.

    Payment Arrangements:

    • On completion of telehealth assessment an invoice will be emailed for full payment amount to be received prior to any outcome documentation, reporting or quoting being provided by the assessor (Nurse Continence Specialist) to the NDIS participant or relevant Nominee.
    • For home visit face to face assessments invoicing and receipt of full payment will be required prior to home visit being attended.
    Stacey Dubberley - Nurse Continence Specialist ABN 23 910 467 922
    Email: ndisnursecontinencespecialist@gmail.com
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