Privacy Collection Notice
Consent to Collect, Use and Disclose Personal Health Information
Your privacy is important to The Shine Centre.
The Shine Centre collects the personal information you provide on this form for the purpose of:
To assisst with your service enquiry, we ask that you provide us with your personal details and health information, so that we may properly assess your service enquiry. We require your consent to collect, use, and disclose your personal health information.
You have a right to ask to alter or withdraw consent at anytime.
The information The Shine Centre collects includes:
The name of the person enquiring about services and their relationship to the participant
The clients name (if different to the person referring)
Contact details (phone and email)
The services you are enquiring about
Funding status (e.g,. NDIS, Medicare, or private)
Whether their are client risks or safety risks The Shine Centre should be aware of
The Shine Centre respects your rights and ensures all personal and health information remains private and confidential. Your health information refers to information pertaining to your health, medical history, and past and future medical care. The Shine Centre is bound by the Privacy Act 1988 (Cth) and endeavors to uphold the Australian Privacy Principals in collecting, maintaining and storing personal medical information in a private and secure manner.
The Shine Centre will not disclose your personal information to third parties without your consent unless:
Required or authorised by law
It is necessary to prevent a serious threat to health or safety
It is required for mandatory reporting or safeguarding obligations
Access and Corrections to your Health Information
You have a right to access your personal health information. On receiving an application for a request to access your personal health information The Shine Centre will respond to the request for access within a reasonable period and give access to the individual, if it is reasonable and practicable to do so.
Full or partial access to your health records may be refused in circumstances where:
Disclosure of personal health information may result in physical or mental harm to you or any other person the information may impact on the privacy of other individuals
Information relates to existing or anticipated legal proceedings
If access would prejudice negotiations with the individual
Where denying access is required or authorised by law
If The Shine Centre refuses to grant access to the personal health information requested, or give access in the form requested, The Shine Centre will provide written notice that sets out the reasons for the refusal (except where disclosure of the reasons would be inappropriate) and the mechanisms available to complain about the refusal.
You have the right to requeste an ammendment to your personal health information, should you believe it contain inaccurate information. Requests to ammed your personal health information should be directed to The Shine Centre's Practice Manager. The Shine Centre will respond to all requests to correct personal health information within a reasonable period after the request is made.
Consent to Collect and Share Information
By consenting below, I acknowledge that:
I have the legal right or consent of the individual to make this service enquiry and to disclose personal health information pertaining to the individual
I have read the information above and understand the reasons for why my information must be collected.
I understand that I am not obliged to provide any information requested of me, but failure to do so may significantly compromise the quality of information The Shine Centre can provide about our services.
I am aware of my rights to access the information collected about me, except in the circumstances where be legitimately withheld. I will be given an explanation in these circumstances.
I am aware of my right to request and amendment to information I believe is incorrect.
I understand that if my information is to be used for any other purpose other than that set out above, my consent will be obtained.