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  • NDIS Support Worker Referral

  • PARTICIPANT DETAILS

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  • MAIN CONTACT/NOMINEE DETAILS

    (IF DIFFERENT FROM ABOVE)
  • SUPPORT COORDINATOR DETAILS

  • FINANCE CONTACT

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  • NDIS Support Worker Referral

  • PARICIPANT BACKGROUND INFORMATION

  • HEALTH/SAFETY INFORMATION

  • ADDITIONAL INFORMATION

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  • NDIS Support Worker Referral

  • SCHEDULE OF SUPPORTS

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  • NDIS Support Worker Referral

  • PRIVACY CONSENT

  • Phoenix will work closely with other agencies to coordinate the best support for you. We need your consent to share your information, except when:

    • 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 acknowledge that Phoenix has advised me of the following:

    • Phoenix’s Privacy and Confidentiality Policy and Procedure;
    • my right to access my personal information; and
    • my right to withdraw my consent at any time.

     

    I give consent for Phoenix to:

    • collect the information, including audio and visual records, needed to provide me services;
    • store information about me;
    • obtain a copy of my NDIS plan and any relevant reports/assessments relating to my disability;
    • I give my consent for Phoenix to contact service providers relevant to meet my support needs and in-line with my NDIS specific goals, with the objective of information gathering, sharing, and support planning;
    • allow staff, who need my information to provide services to me, access to information about me;
    • share my information except with the people and/or organisations listed below.

     

    I give consent for Phoenix Specialised Youth & Disability Services to act on my behalf to complete referrals, share information and gather relevant information to implement my support needs.

     

    By agreeing to the above, you are giving permission for Phoenix staff to discuss with appropriate individuals/service providers any relevant medical and personal information regarding your support needs.

     

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