PARTICIPANT CONSENT FORM

PARTICIPANT CONSENT FORM
J Bromilow CHAMP Enterprises Pty Ltd t/a NDIS Financial Care Plus will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

We are obliged by law to disclose your information regardless of consent or otherwise
it is unreasonable or impracticable to gain consent or consent has been refused;
and the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.
I, _____________________________________________ hereby acknowledge that J Bromilow CHAMP Enterprises Pty Ltd t/a NDIS Financial Care Plus has advised
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Do you want the information to be shared with appropriate authorities such as health professionals, pharmacies, medical specialists etc?

YESNO
Name of participant or Authorised Representative

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Name of Staff MemberJ Bromilow CHAMP Enterprises t/a NDIS Financial Care Plus

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STAFF USE ONLY
Verbal Consent

Verbal consent should only be used where it is not practicable to obtain written consent.

I have discussed the proposed referrals with the client or authorised representative and I am satisfied that they understand the proposed uses and disclosures and have provided their informed consent to these.
For J Bromilow CHAMP Enterprises Pty Ltd T/A NDIS Financial Care Plus use only.
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