Consent to Share Information Form

Consent to Share Information

4U PLAN MANAGERS
Please use this form to give your permission (consent) for 4U Plan Managers to share your National Disability Insurance Scheme (NDIS) financial information with a person or an organisation who you choose.

You can take away your consent at any time. You can let us know by email, in person or over the phone that you no longer consent to us sharing information on your behalf.

Parties with consent can request the following financial information:
- NDIS plan expenditure and available funds
- Copies of processed invoices
- Funding statements and other funding reports
Do you have a support coordinator? Grant them access to the Careview Connect Portal that allows them to view your NDIS plan funding in real-time and processed invoices. This enables them to easily coordinate your NDIS supports and get the most out of your funding.
1. Participant Information
Full Name
NDIS Number
2. Authorised Parties
How many parties can 4U Plan Managers to share information with?*
Name
Company (if applicable)
Relationship to Participant
Contact Number
Email
Careview Connect Access (NDIS support coordinators only)
Name
Company (if applicable)
Relationship to Participant
Contact Number
Email
Careview Connect Access (NDIS support coordinators only)
Name
Company (if applicable)
Relationship to Participant
Contact Number
Email
Careview Connect Access (NDIS support coordinators only)
3. Declaration
Signature of participant / nominated representative*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Consent to Share Information

1. Participant Information

2. Authorised Parties

3. Declaration