Patient Registration

We require your consent to collect personal information about you and your child. Please read the following information about privacy issues, practice requirements and fees carefully, and confirm where indicated below.

This practice collects information from you regarding your child for the primary purpose of providing quality health care. We ask you to provide us with details about both your own and your child’s personal and medical history so that we may properly assess, diagnose and treat your child. This means we will use the information in accordance with the Australian Privacy Principles in the following ways:

• Administration purposes for this medical practice.

• Billing purposes including compliance with Medicare and Health Insurance Commission requirements

• Disclosure to others involved in your child’s healthcare, including treating doctors and specialists outside this medical practice. This may occur through referral to other doctors, or for medical tests (i.e. radiology and pathology services) or in reports or results returned following referrals. This information may be communicated by mail, facsimile and/or email (encrypted and unencrypted).

• Disclosure to other doctors in the practice, locums, and medical students and by registrars attached to the practice for the purpose of patient care and teaching.

• We may also need to communicate with teachers, allied health providers and other professionals involved in your child’s care. Please let us know if you do not want your records accessed for these purposes. This will be noted accordingly.

• In an emergency situation where it is in the best interest of your child’s health, we would disclose appropriate information if requested to do so.

• I have read this form and understand why collecting this information is necessary and the circumstances in which the information may be used or disclosed. I am also aware that this practice has a privacy policy on handling patient information.
  

• I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of the healthcare and treatment given to my child.

• I am aware of my right to access the information collected about my child, except in some circumstances where access might legitimately be withheld. I will be provided with a written reason if access is denied.

• I understand that if my information is to be used for any purpose other than set out above; my further consent will be obtained.

• I consent to the handling of my information by this practice for the purposes set out above, subject to any limitation on access or disclose thaT I notify the practice of.

• To allow Dr Madhwan to focus on you and your child and provide the best care and attention, a medical scribe called Lyrebird may be used during your visit. This helps to create notes of the consultation. Please be reassured that this is a secure system with confidentiality maintained. If you do not want this to be used, please let Dr Madhwan know, and it can be turned off. More information can be provided on request.
  

• I agree to abide by the following practice procedures:

• It is my responsibility to ensure that I have a current referral from my GP every 12 months or for any new issue.

• If I fail to attend an appointment or do not give more than 24 hours’ notice of my cancellation, I may be

• charged a non-refundable attendance fee as per the policy.

• My child must be in attendance at all appointments (if not a Medicare rebate is not claimable)

• I understand that the cost of the consultation is above the Medicare Schedule fee, which means I will incur an out of pocket expense. I agree to pay the account in full at the time of the consultation.

• I have read this form and a member of staff has, at my request, clarified aspects of it that I have not understood