New Patient Form

INTRODUCTION

We are committed to protecting the privacy of patient information and to handling your personal information in a responsible manner in accordance with the Privacy Act 1988 (Commonwealth), the Privacy Amendment (Enhancing Privacy Protection) Act 2012, the Australian Privacy Principles and relevant State and Territory privacy legislation (referred to as privacy legislation).

This Privacy Policy explains how we collect, use and disclose your personal information, how you may access that information and how you may seek the correction of any information. It also explains how you may make a complaint about a breach of privacy legislation.

This Privacy Policy complies with all applicable guidelines, codes of conduct, and laws relating to privacy and confidentiality. From time to time, we may make changes to this policy, processes and systems in relation to how we handle your personal information. We will update this Privacy Policy to reflect any changes. Those changes will be available on The Bubble website and in the practice.

COLLECTION

We collect information that is necessary and relevant to provide you with medical care and treatment, and management of the medical practice. This information includes your name, address, date of birth, gender, health information, family history, and contact details. This information may be stored on the computer medical records system.

Wherever practicable we will only collect information from you personally. However, we may also need to collect information from other sources such as treating specialists, radiologists, pathologists, hospitals and other health care providers. We collect information in various ways, such as over the phone or in writing, in person in the practice or over the internet if you transact with us online. This information may be collected by medical and non-medical staff. In emergency situations we may also need to collect information from your relatives or friends.

We are required by law to retain medical records for certain periods of time depending on your age at the time we provide services.

USE AND DISCLOSURE

We will treat your personal information as strictly private and confidential. We will only use or disclose it for purposes directly related to your care and treatment, or in ways that you would reasonably expect that we may use it for your ongoing care and treatment. For example, the disclosure of blood test results to your specialist or requests for x-rays. There are circumstances where we may be permitted or required by law to disclose your personal information to third parties. For example, to Medicare, Police, insurers, solicitors, government regulatory bodies, tribunals, courts of law, hospitals, or debt collection agents. We may also from time to time provide de-identified statistical data to third parties for research purposes with approved privacy policies.

We may disclose information about you to outside contractors to carry out activities on our behalf, such as an IT service provider, solicitor or debt collection agent. We impose security and confidentiality requirements on how they handle your personal information. Outside contractors are required not to use information about you for any purpose except for those activities we have asked them to perform.

DATA QUALITY AND SECURITY

We will take reasonable steps to ensure that your personal information is accurate, complete, up to date and relevant. For this purpose, the staff may ask you to confirm that your contact details are correct when you attend a consultation. We request that you let us know if any of the information we hold about you is incorrect or out of date.

Personal information that we hold is protected by:

• securing the premises;
• placing passwords and varying access levels on databases to limit access and protect electronic information from unauthorised interference, access, modification and disclosure; and
• Security training is conducted with all staff – personal signed documents are signed by all staff stipulating the confidentiality requirements.

CORRECTIONS

If you believe that the information, we have about you is not accurate, complete or up-to-date, we ask that you contact us in writing (see details below).

ACCESS

You are entitled to request access to your medical records. We request that you put your request in writing and we will respond to it within a reasonable time.

There may be a fee for the administrative costs of retrieving and providing you with copies of your medical records.

We may deny access to your medical records in certain circumstances permitted by law, for example, if disclosure may cause a serious threat to your health or safety. We will always tell you why access is denied and the options you have to respond to the decision.

COMPLAINTS

If you have a complaint about the privacy of your personal information, we request that you contact us in writing. Upon receipt of a complaint, we will consider the details and attempt to resolve it in accordance with the complaints handling procedures.

If you are dissatisfied with our handling of a complaint or the outcome you may make an application to the Australian Information Commissioner or The Tasmanian Office of the Ombudsman and Health Complaints Commissioner.

OVERSEAS TRANSFER OF DATA

We will not transfer your personal information to an overseas recipient unless we have your consent or we are required to do so by law.

CONTACT

Please direct any queries, complaints, requests for access to medical records to:

Attn: The Practice Manager
The Bubble Launceston
4/23 Brisbane Street
Launceston TAS 7250

TERMS AND CONDITIONS

• Payment in full is required at the time of consultation.
• If an account remains unpaid, no further medical services will be provided.
• Payment of non-attendance and cancellation fees are an obligation to be a patient at this practice.
• If payment isn't received within 28 days of the consult, further actions will be taken.

APPOINTMENT TIMES

Often patients will have multiple issues to discuss. If the practitioner cannot cover every aspect in a single consultation, the patient may be asked to come back for a subsequent visit. This is done to ensure the best quality care possible.

The practitioner's do their best to run to time – however, we endeavour to and do run to time in most instances, emergencies and unforeseen circumstances may occasionally result in delays beyond our control. We trust that affected patients will be understanding in the rare event that this may occur, and we always aim to contact patients if this occurs to ensure you are not kept waiting.

CANCELLATIONS

When you book your appointment, you are holding a space that is no longer available to other patients. These appointments are an hour long therefore on day cancellations and non-attendance fees will apply. We politely ask that you please respect that the practitioner often has limited appointment times, and that you provide us with 24 hours notice should you need to reschedule or cancel your appointment.

To help you keep your appointment, reception staff send reminders 2 business day prior which ask that you reply to by SMS or return phone call. Please remember that if for some reason you do not receive your reminder, your appointment remains your responsibility to attend, reschedule or cancel.

If you need to cancel your appointment after receiving your SMS reminder, we are of course understanding of this and will cancel or reschedule your appointment. If you cancel your appointment with less than 24 hours notice prior to your appointment, you will incur a $100.00 cancellation fee. We also understand emergencies can pop up from time to time, please ensure you notify reception staff of your reason for cancelling. In the event of recurrent cancelled appointments, this will result in a charge of a full consult fee. The Bubble also reserves the right to charge a non-refundable deposit before making another appointment.

If you need to cancel your appointment, please:

• Call us - 6724 3063
• Respond 'cancel' to the SMS reminder
• Email us - admin@thebubblelaunceston.com.au
• Use our contact us page

Emails and contact us page submissions are monitored on a regular basis by reception staff.

MISSED APPOINTMENTS

Missed appointments represent a cost to both the practice, and to other patients who could have been seen in the time set aside for you. These appointments are an hour long therefore on the day cancellations and non-attendance fees will apply. Please advise us as soon as possible if you cannot attend an appointment. This allows us to offer your appointment to someone else who may need urgent treatment.

New Patients
In the event where you do not attend for your initial appointment, it will result in a non-attendance fee of $100.00. If payment isn't received within 28 days, further actions will be taken. The Bubble also reserves the right to charge a non-refundable deposit before making another appointment.

Existing patients
Since we turn away other patients to hold your appointment, 1 missed appointment will result in a non-attendance fee of $100.00. A second missed appointment will result in a charge of a full consult fee of $200.40. If payment isn't received with 28 days of the account, further actions will be taken. The Bubble reserves the right to charge a non-refundable deposit before making another appointment.

TELEHEALTH

Although face to face appointments are preferred, the practitioner can offer a telehealth service (video consult) to patients. This is an option if you are unable to attend in the clinic (ie COVID-19). Please advise reception staff if you wish for your appointment to be changed to a video consult.

The same as in clinic, payment is still required at the time of consultation. Reception staff will contact you shortly after your consult to discuss payment options.

LATE ARRIVALS

In order to provide a fair and timely service to all patients, we require that patients who have made a booking arrive promptly for their appointment. If you are attending the clinic for the first time we ask that you arrive at least 10 minutes prior to your allocated time, to allow timely completion of your new patient paperwork if this hasn’t been completed online prior.

Arriving late deprives you of precious minutes, as each session will be finished on time as a courtesy to our next patient.

We fully understand that sometimes being late is outside of your control, and we will always do our best to accommodate late arrivals. We ask that you contact us if you are concerned you may be late.

Unfortunately, arriving too late to your consult may results in rescheduling.

This practice has produced a Privacy Policy that outlines the way we collect and use your information and how you can access that information.

This consent form covers collection and use of your information (including your Government issued Individual Health Identifier) to provide comprehensive, co-ordinated and continuing whole person medical care. As outlined in the Privacy Policy, your information may be disclosed to other health care professionals to provide this level of care. In addition, there are circumstances when information has to be disclosed such as:

• Emergency situations
• Public health statutory requirements on notifiable diseases
• Medical indemnity insurance obligations
• Provision of information to Medicare or private health funds for billing and rebate purposes
• Quality assurance purposes

The Bubble Launceston participates in a recall and reminder system to ensure we provide high quality care. This means that when you are due for routine preventative health measures such as cervical screening, intrauterine device or contraceptive etc. we will contact and advise you to make an appointment.

If you have had any pathology, imaging, or other testing done through The Bubble Launceston, we will contact you regarding the results if the doctor advises it needs a follow up. We strongly advise and would be in your best interest that you ring to follow up your test results within the time frame advised by your GP.

The Bubble Launceston sends SMS appointment reminders and recalls to the disclosed mobile phone number by the patient. All messages sent identify the practice as the caller and/or sender.

We feel that the above measures are a fundamental part of the high-quality healthcare and we strive to give to all our patients. To aid this it is essential we have your most recent contact details and that you advise the practice of any changes.

Separate and specific consent is required if your information is to be used for research or statistical purposes, or if any third party eg. insurance company, workers compensation, or employer requests your medical information. By signing this consent form, you acknowledge that you have read and you agree to your information being collected and used as described above.

I consent to participate in the scheduled reminder system as described above.

I consent to being contacted for review of test results as may occur from time to time.

I consent to have SMS appointment reminders and recalls sent to my disclosed mobile phone number that identify the practice as the caller and/or sender.

As part of providing a psychological service to you, Amy Farrell needs to collect and record personal information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information as part of providing psychological services to you. This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.

PURPOSE OF COLLECTING AND HOLDING INFORMATION

Your personal information is gathered as part of your assessment and treatment, is kept securely and, in the interests of your privacy, used only by your psychologist and the authorised personnel of the practice (as necessary). Your personal information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service to you. A more detailed description is provided in The Bubble’s Privacy policy.

CONSEQUENCE OF NOT PROVIDING PERSONAL INFORMATION

If you do not wish for your personal information to be collected in a way anticipated by this letter or the Privacy Policy, Amy Farrell may not be in a position to provide the psychological service to you. In most cases it will not be possible for you to be anonymous or to use a pseudonym.

ACCESS TO CLIENT INFORMATION

At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. The psychologist may discuss with you different possible forms of access.

DISCLOSURE OF PERSONAL INFORMATION

All personal information gathered by the psychologist during the provision of the psychological service will remain confidential except when:

1. Is subpoenaed by a court, or disclosure is required or authorised by law; or
2. Failure to disclose the information would in the reasonable belief of Amy Farrell/The Bubble Launceston place you or another person at serious risk to life, health or safety; or
3. Your prior approval has been obtained to:
   1. Provide a written report to another professional or agency (e.g. a GP or a lawyer); or
   2. Discuss the material with another person (e.g. a parent, employer, health provider or third party funder); or
   3. Disclose the information in another way; or
   4. Disclose to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected.

Your personal information is not disclosed to overseas recipients, unless you consent or such disclosure is otherwise required by law. Your personal information will not be used, sold, rented, or disclosed for any other purpose. In the event that unauthorised access, disclosure or loss of a client's personal information occurs, The Bubble will activate its data breach plan and use all reasonable endeavours to minimise any risk of consequential serious harm.

I have read and understood this consent form. I agree to the above conditions for the psychological service provided by Amy Farrell.