New Patient Information

It is the policy of this practice to ensure the confidentiality and security of the personal and health information of those attending. It is also the policy of the practice to abide by the requirements of the Privacy (Private Sector) Amendment Act 2000.

It is necessary to collect personal information from you for the primary purpose of assisting the development of diagnosis, treatment and further advice concerning a particular health condition, suspected health condition or circumstance relating to health.

If you do not provide some or all of your personal information, we may not be able to provide you with appropriate treatment. The personal and health information collected will be used in the following areas:

• Administrative purposes in running the medical practice.
• Billing purposes, including compliance with the Health Insurance Commission and Department of Veterans’ Affairs requirements.
• Disclosure to others involved in your health care (including treating doctors, specialists, and other healthcare professionals outside this medical practice). This may occur through referral to other doctors, referral for medical tests and in the reports or results returned to this practice following referral.
• Disclosure to medical staff of the hospitals and medical practices where this will be of importance in the furtherance of your health care.
• Disclosure for research and quality assurance activities to improve individual and community practice.
• Disclosure to legal and insurance enquiries where such evaluations and information is required for the proper conduct, elucidation and compensation of the matter in hand.
• Disclosure to industry partners where this will be of importance in troubleshooting for issues that arise in the management and treatment of your health care (including industry partners who are outside Australia).
• Analytic tools to identify trends and patterns for improving health management and healthcare outcomes.

Our Privacy Policy contains more information about the way we collect and manage personal information. Our Privacy Policy is available on our website at www.5dclinics.com.au.

We may also collect other sensitive information (besides your health and medical information), which includes details of your cultural or linguistic background.

I have read the information provided above and understand the reasons my personal and health information is required to be collected. I am also aware that this practice has a Privacy Policy pertaining to the handling of personal health information of its patients.

I understand that I am not obliged to provide any information requested of me, but that failure to do so might compromise my health care, treatment of – where applicable – the proper evaluation of my medical condition.

I am aware of my right to access the personal and health information collected, except in some circumstances where access might legitimately be withheld. I understand that if my personal and health information is to be used for any other purpose other than set out above, or in the privacy policy my further consent will be obtained (unless otherwise ordered by a court of law.)

I consent to the collection and disclosure of my personal and medical information and the handling of my personal health information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify to this practice.