Health and Privacy Information

This practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and a medical history so that we may properly assess, treat and be proactive in your health care needs. This means we will use this information you provide in accordance with the Australian Privacy Principles and the Victorian Health Privacy Principles Records Act for:

•Administrative purposes in running our practice;
• Billing purposes, including compliance with Medicare and Health Insurance Commission requirements;
•Disclosure to others involved in your health care, including treating doctor and specialists outside this practice. This may occur through referral to other doctors or for medical tests and in the reports or results returned to us following the referrals.

I have read the information above and understand the reasons why my information must be collected. 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 from me but that my failure to do so might compromise the quality of the health care and treatment given to me. I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.

I understand that if my information is to be used for any other 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 limitations on access or disclosure that I notify this practice of.

Patient Financial Responsibility:

• I am requesting that Peninsula Hand Therapy provide the therapy services prescribed by my physician.
•I understand that I am responsible for obtaining referrals for these services if necessary.
•I understand that I am responsible for the cost of these services if my insurer does not fully cover or denies payment. These services include splints, supplies and therapy treatments. I further understand that it is ultimately my responsibility to fully understand the extent and limits of my benefit coverage.
•I also understand that any costs in debt recovery for unpaid accounts will be added to my account and that I will be responsible for admin fees for late cancellation or did not attend.