• Referral to Social Work

    Referral to Social Work

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  • Referrers Details

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  • Education

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  • What best describes the main issue right now?

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  • If you are concerned about your child's immediate safety or well-being, this form is not the right pathway for urgent support.

     

    Please contact:

    • Your GP or local emergency department
    • Lifeline 13 11 14 (available 24/7)
    • Beyond Blue 1300 22 4636

     

    For community-based and urgent family supports, please visit:

    • www.wildchildpaediatrics.com/urgent-support-and-crisis-policy/
  • Impact and Supports

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  • Goals and Booking Request

  • Release of information - School/Education Provider

  • I/We give permission for Wild Child Paediatrics to request and recieve information from my child's school or education provider for the purpose of assessment, care planning and educational support.

    This may include school reports, individual behaviour or education plans and direct communication with relevant school staff.

    Where clinically appropriate, this may also include telephone or email contact and school observation. I/We understand that if a school observation is required this will be discussed with us beforehand.

  • PRIVACY ACT 1988

             PATIENT/PARENTAL CONSENT TO COLLECT & DISCLOSE INFORMATION

    The Privacy Act 1988 requires medical practitioners to obtain consent from their patients to collect, use and disclose that patient’s personal information.

    Collection

    This means we will collect information that is necessary to provide proper advice and treatment. Such necessary information may include;-

    • Full and detailed medical history
    • Family medical history
    • Ethnicity
    • Contact details
    • Medicare/private health fund details
    • Genetic information
    • Billing/account details

    The information will normally be collected directly from you and/or your child. There may be occasions when we will need to obtain information from other sources.

    For example;-

    • Other medical practitioners, such as GP’s and specialists
    • Other health care providers such as physiotherapists, occupational therapists, psychologists, pharmacists, dentists, nurses
    • Day care, teachers, child carers
    • Hospital and Day Units

    Both our practice staff and the medical practitioners may participate in the collection of this information.

    In emergency situations, we may need to collect personal information from relatives or any other resources where we are unable to obtain your prior express consent.

    Use & Disclosure

    With your consent, the practice staff will use and disclose you/your child’s information for purposes such as;-

    • Providing advice to the referring doctor
    • Referral to another medical practitioner or health care provider
    • Sending specimens such as blood samples for analysis
    • Referral to a hospital for treatment and/or advice
    • Advice on treatment options
    • To prevent or lessen a serious threat to an individual’s life, health or safety
    • Account keeping and billing purposes
    • Where legally required to do so such as producing records to court, or the notification of diagnosis of certain communicable diseases.

    Access to any information or records can be denied where;-

    • To provide access would create a serious threat to life or health
    • There is a legal impediment to access
    • The access would unreasonably impact on the privacy of another
    • Your request is frivolous
    • The information relates to anticipated or actual legal proceedings and you would not be entitled to access the information in those proceedings
    • In the interest of national security

    A request for medical information may be denied at the discretion of the treating doctor.

    All requests for information must be made in writing with permission from both parents in shared custody arrangements, as well as the patient if the patient is aged 12 years and over.

    An administration fee may be charged for the time involved in processing your request. Where you dispute the accuracy of the information we have recorded, you are entitled to place in writing your requested correction which will be kept with the patient’s records. An amended document may be provided however, we will not erase the original record.

    Any request for medical information may be denied at any time at the discretion of the treating doctor.

    For further information please see our Privacy Policy.

    Consent

    I provide my consent for this medical practice by all staff and doctors to collect, use and disclose my/my child’s personal information as outlined above.

    I understand that I am entitled to access my child’s records which must be made in writing with permission from both parents in a shared care custody arrangement, as well as the patient if aged 12 years and over, except where access would be denied as outlined above.

    I understand that I may withdraw my consent at any time and that this must be in writing with permission from both parents in a shared care custody arrangement, as well as the patient if aged 12 years and over, except when legal obligations must be met.

  • Consent for the Use of Artificial Intelligence (AI) Tools

  • At Wild Child Paediatrics, we may use Artificial Intelligence (AI) tools to assist in administrative tasks and document preparation, such as drafting summaries, reports, or streamlining data entry. These tools are not used for clinical decision-making and are supervised by qualified healthcare providers.

    This form seeks your consent to utilize AI tools during your care while ensuring your personal information is handled securely and in compliance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles.

     
    What AI is Used For:

    1. Assisting with administrative tasks, such as drafting appointment summaries or reports.

    2. Improving the efficiency of document preparation to ensure timely service.

     
    What AI Tools Are NOT Used For:

    • Diagnosing medical conditions.

    • Making treatment decisions.

     All clinical decisions remain the sole responsibility of our qualified healthcare providers.

     

    Data Security and Privacy

    Your data is processed in compliance with Australian privacy regulations. AI tools used in our practice:

    • Handle data securely and in encrypted formats.

    • De-identify personal information wherever possible.

    • Are reviewed and supervised by our healthcare team.

     Your identifiable health data will not be shared with third parties through the use of these tools.

     For further information please see our Privacy Policy.

    Consent

    I/We consent to the use of Artificial Intelligence (AI) tools for administrative and document preparation purposes as part of my child's care at Wild Child Paediatrics.


    I understand that:

    1. AI tools are not used for diagnosing or making clinical decisions.

    2. My child's data will be handled securely and in accordance with Australian privacy laws.

    3. I can withdraw my consent at any time by notifying Wild Child Paediatrics.

     

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