Permalink Consent Form

Personal information collection, holding, use and disclosure of personal information by Permalink Support Services is protected by the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) (Privacy Act)

Personal information is any information or an opinion that identifies you or could identify you and includes information about your health.

The purpose for collecting personal information from you is to:

• provide services, including planning, coordinating, funding, implementing, monitoring and reviewing our services
• Report to NDIS, Government or other funding bodies of how funding is serviced by us
• Take photographs and videos for therapeutic and marketing purposes
• Responding to your feedback
• Responding to your queries

*Please note that Permalink Support Services is required to release information about service users (without identifying you by full name or address) to the Disability Services Commission and to the Australian Institute of Health and Welfare, to enable statistics about disability services and their clients to be compiled. The information will be kept confidential. This information is used for statistical purposes only and will not be used to affect your entitlements or your access to services. As a user of National Disability Agreement services, you have the right to access your

Permalink Support Services will not disclose/use information about you for any secondary purpose unless:

• Your have consented to the use or disclosure
• You would reasonably expect Permalink Support Services to use or disclose the information for the secondary purpose as it is directly related to the primary purpose
• The use or disclosure of the information is required or authorised by or under an Australian Law or a court/tribunal order
• Permalink Support Services reasonably believes the use or disclosure is necessary to lessen or prevent a serious threat to life, health or safety of an individual or to public health and safety
• Permalink Support Services has reason to suspect an individual may have done something unlawful or engaged in serious misconduct that relates to Permalink Support Services functions or activities
• Permalink Support Services reasonably believes that the use or disclosure is reasonably necessary to assist another person to locate a person reported as missing.
  

If my/our circumstances change I agree to notify Permalink Support Services as soon as practicable. Client's Name:Signed by: Date:

Note: Where a client does not have the capacity to give informed consent and does not have a legal guardian who has the authority to make decisions on behalf of the client, the client's parent, family member or other person with a close personal relationship to the client may sign this form. The person who signs on the client's behalf must print their relationship to the client next to their name. Please send completed forms to:Permalink Support Services Email: support@permalink.com.au Post: 164 Rosebank Avenue, Clayton South VIC 3169

Pursuant to The Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) and The Health Information Protection Act The purpose of this form is to provide consent to the release of personal information to third parties as requested by the Client which is protected and governed by the privacy provisions of The Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) and The Health Information Protection Act.

I understand this may include personal information within the meaning of The Freedom of Information and Protection of Privacy Act, and personal health information within the meaning of The Health Information Protection Act.

I further understand that Permalink Support Services will only release as much information as is needed to respond to my concern and subject to the restrictions and provisions of The Freedom of Information and Protection of Privacy Act 2012 (Cth) and The Health Information Protection Act.

Consenting to the Release of Personal Information: