Covid Vaccine Consent Form
New Patient Form
Current as of 14th December 2021
Why and when your consent is necessary
When you register as a patient of our practice, you provide consent for our GPs and practice staff to access and use your personal information so they can provide you with the best possible healthcare. Only staff who need to see your personal information will have access to it. If we need to use your information for anything else, we will seek additional consent from you to do this.
Why do we collect, use, hold and share your personal information?
Our practice will need to collect your personal information to provide healthcare services to you. Our main purpose for collecting, using, holding and sharing your personal information is to manage your health. We also use it for directly related business activities, such as financial claims and payments, practice audits and accreditation, and business processes (e.g. staff training).
What personal information do we collect?
The information we will collect about you includes your: • names, date of birth, addresses, contact details • medical information including medical history, medications, allergies, adverse events, immunisations, social history, family history and risk factors • Medicare number (where available) for identification and claiming purposes • healthcare identifiers • health fund details.
Dealing with us anonymously
You have the right to deal with us anonymously or under a pseudonym unless it is impracticable for us to do so or unless we are required or authorised by law to only deal with identified individuals.
How do we collect your personal information?
Our practice may collect your personal information in several different ways.
1. When you make your first appointment our practice staff will collect your personal and demographic information via your registration form.
2. During the course of providing medical services, we may collect further personal information. This may include electronic transfer of prescriptions (eTP), My Health Record, HealthLink, or the Australian Immunisation Register.
3. We may also collect your personal information when you visit our website, send us an email, or telephone us.
4. In some circumstances personal information may also be collected from other sources. This may be because it is not practical or reasonable to collect it from you directly. This may include information from: • your guardian or responsible person • other healthcare providers involved in your care, such as specialists, allied health professionals, hospitals, community health services, pathology and diagnostic imaging services • your health fund, Medicare, or the Department of Veterans’ Affairs (as necessary)
When, why and with whom do we share your personal information?
We sometimes share your personal information:
• with third parties who work with our practice for business purposes, such as accreditation agencies or information technology providers – these third parties are required to comply with APPs and this policy - or with employers or employment agencies when a medical assessment and/or procedure is required
• with other healthcare providers
• when it is required or authorised by law (eg: court subpoenas)
• when it is necessary to lessen or prevent a serious threat to a patient’s life, health or safety or public health or safety, or it is impractical to obtain the patient’s consent
• to assist in locating a missing person
• to establish, exercise or defend an equitable claim, or to process a confidential dispute resolution
• when there is a statutory requirement to share certain personal information (eg: some diseases require mandatory notification)
• during the course of providing medical services through HealthLink, (eg: via Service NSW for Fitness to Drive Medical Assessments)
Only people who need to access your information will be able to do so. Other than in the course of providing medical services or as otherwise described in this policy, our practice will not share personal information with any third party without your consent.
We will not share your personal information with anyone outside Australia (unless under exceptional circumstances that are permitted by law) without your consent.
Our practice will not use your personal information for marketing any of our goods or services directly to you without your express consent. If you do consent, you may opt out of direct marketing at any time by notifying our practice in writing.
How do we store and protect your personal information?
Your personal information may be stored at our practice as paper records, in electronic formation, or as visual records (Xrays, CT scans, or photos. Our practice stores all personal information securely. Paper records are stored in a locked and alarmed secure building, and all electronic records are password protected, with limited access. Back-ups of electronic records are also stored in separate external HDD storage.
How can you access and correct your personal information at our practice?
You have the right to request access to, and correction of, your personal information. You may request amendments in writing to: Noelle Dalgliesh, Practice Manager, Union Street Family Medical Practice, 11 Union St. MACLEAN NSW 2463. Our practice acknowledges that patients may request access to their medical records. We require you to put this request in writing and our practice will respond within 30 days. There may be a small fee associated with providing this information, to cover costs incurred. If a fee is applicable, you will only be charged when the request is completed. Our practice will take reasonable steps to correct your personal information where the information is not accurate or up to date. From time to time, we may ask you to verify that your personal information held by our practice is correct and current.
How can you lodge a privacy-related complaint, and how will the complaint be handled at our practice?
We take complaints and concerns regarding privacy seriously. You should express any privacy concerns you may have in writing, or via our complaints form. We will then attempt to resolve it in accordance with our resolution procedure, and respond within 30 days, if required. You can direct your correspondence to: Noelle Dalgliesh, Practice Manager, Union Street Family Medical Practice, 11 Union St. MACLEAN NSW 2463. Ph: (02) 66 452255 You may also contact the OAIC. Generally, the OAIC will require you to give them time to respond before they will investigate. For further information visit www.oaic.gov.au or call the OAIC on 1300 363 992.
Policy review statement
➢ Patients and others have opportunities to register their complaints either verbally to staff and/or the practice manager, in writing (letter) or via our suggestion box. Patients should feel free to complain anonymously if desired.
➢ All staff should be prepared to address complaints as they arise.
➢ When receiving complaints staff should keep in mind the following in order to minimise further patient anxiety and hostility, possibly leading to litigation:
handle all complaints seriously, no matter how trivial they may seem.
verbal complaints made in person should be addressed in a private area of the practice where possible.
use tactful language when responding to complaints.
don’t blame other staff. Patients may not have all the facts or may distort them.
address the patient’s expectations regarding how they want the matter resolved.
assure the patient that their complaint will be investigated and the matter not overlooked.
offer the patients the opportunity to complete a formal complaint form. (They may accept or decline).
document or log all complaints and other relevant information and place this in the complaints folder for the attention of the designated complaints staff member, (even if you believe the matter has been resolved).
alert the doctor or relevant clinical staff about disgruntled or hostile patients so he/she can defuse the situation immediately.
always inform the designated complaints officer/ practice manager if you become aware of any significant statements made by the patient or significant change in patient attitude. Often patients will tell staff when they are reluctant to tell the doctor.
ensure documentation is recorded in the appropriate notes.
➢ The practice has identified Noelle Dalgliesh (practice manager) to be the team leader responsible for feedback collection and analysis and handling complaints. Noelle coordinates the investigation and resolution of complaints. She will:
acknowledge the patient's right to complain
use the Acknowledgment of Complaint letter provided and respond to complaints in writing as soon as possible.
telephone the patient to let him/her know that she is working on the problem.
respond to all complaints promptly in an open and constructive manner including an explanation and, if appropriate, an apology. • work with the patient to resolve the problem, and communicate the outcome with the patient including any changes made as a result of the complaint.
refer the complaint to a doctor if it is of a medical nature.
provide a staff member about whom a complaint has been made, an opportunity to discuss the details in a private setting.
contact the practice's insurer when there is a complaint about a member of the clinical team, in order to seek advice on resolution before any action is taken.
ensure the complaint does not adversely affect the patent's care.
record the complaint, investigation, and actions, with a copy placed in the patient’s medical record if related to patient care, and the details also retained in the complaints file.
ensure, where appropriate, that complaints are reviewed at staff meetings.
analyse trends and discuss the methods of resolution. Other types of patient feedback - i.e. surveys, suggestion box are also reviewed at staff meetings
maintain a record of improvements made in response to patient feedback or complaints, as evidence of quality assurance activity.
inform the patient, if appropriate, about practice improvements made as a result of their input.
advise the patient on how to contact the Health Complaints commissioner, if the complaint cannot be resolved.
➢ The National Privacy Commissioner is able to receive complaints concerning privacy issues. Complaints here will have a response within 28 days. National Privacy Commissioner Privacy hotline 1300 363 992. GPO Box 5218 Sydney NSW 2001 http://www.privacy.gov.au/complaints
➢ Members of the public may make a notification to Australian Health practitioner regulation agency (AHPRA) http://www.ahpra.gov.au/ (AHPRA) about the conduct, health or performance of a practitioner or the health of a student. Practitioners, employers and education providers are all mandated by law to report notifiable conduct relating to a registered practitioner or student to AHPRA.
Contacting your Doctor
If you need to speak directly with your GP, please ring the practice and reception staff will assist you. If your doctor is unavailable, staff will notify him/her as soon as possible and a return call will be arranged as soon as practicable.
If the matter is urgent, your call will be triaged and directed to either the doctor or the practice nurse.
Please call 000 and ask for an ambulance if you are in immediate need of life-saving medical attention .
If you have been advised to have a diagnostic test, such as blood tests*, X-rays etc., please book a return appointment so that your GP can discuss the results with you.
To protect your privacy, results will not be given over the phone.
We have a priority results alert system in place, and if this indicates that your results require immediate treatment, we will contact you promptly to arrange an urgent appointment with your doctor.
*We have convenient, on-site pathology services available from Laverty Pathology.
Pathology hours: 8am – 1pm weekdays.