Patient Consent to Collect and Disclose Information

The Privacy Act of 1988 requires medical practitioners to obtain patient consent to collect, use and disclose their personal information.


The practice staff and medical practitioners may participate in the collection of information required to treat and advise you.

This includes:

  • Full medical history, family medical history, genetic information, contact details; Medicare/private health fund, billing and account details

Occasionally, this information is obtained from other sources, for example:

  • Other doctors (current or former), allied health professionals, dentists, hospitals and day surgery units
  • Relatives or other sources, in emergency situations where we cannot obtain your prior express consent.


With your consent, the information is used and disclosed for:

  • Referral to other medical practitioners, health care providers or hospital for treatment options, sending of specimens for analysis,
  • Practice management, audit, quality assurance, accreditation, complaint handling, account keeping, billing
  • To meet our obligations of notification to our medical defence organisations or insurers, to prevent or lessen a serious threat to an individual’s life, health or safety and where legally required to do so, for example, producing records to court, mandatory reporting of child abuse or notification of diagnosis of certain communicable diseases


As part of continuing professional development, a surgeon is responsible for analysing operation outcomes and presenting these results for peer review. Relevant medical information collected for all patients may be used in this audit. The surgeon is bound by strict ethical regulations to de-identify the information so that it cannot be traced to an individual patient. Please discuss this with your surgeon if you have concerns or do not wish to participate in this process.


You are entitled to access your own health records at any time convenient to both yourself and the practice.

This can be denied where:

  • To provide access would create serious threat to life or health
  • There is legal impediment to access, the access would unreasonably impact on the privacy of another, the information relates to anticipated or actual legal proceedings and you would not be entitled to access the information in those proceedings and in the interest of national security

We ask that your request be made in writing. A charge will be imposed for staff time and resources involved in processing your request. Where you dispute the accuracy of the information we have recorded, you are entitled to correct that information. It is our practice policy that we will take all steps to record your corrections and place them with your file, but will not erase the original record.


This is a private practice and all accounts are the responsibility of the patient. The fee for this consultation will NOT be fully covered by Medicare,

All patients are reminded that it is YOUR responsibility to check with your private health fund about the level of cover you may expect on services provided whilst in hospital. Mr Clark is a NO Gap provider and we will bill Medicare and your Private Health directly, for your surgery.


  • I provide my consent for Mr Rhys Clark to collect, use and disclose my personal information as outlined above.
  • I allow the Practice to use email to transfer and receive information to and from parties that are directly related to my care.
  • I understand that I am entitled to access my own health records except where access would be denied as outlined above.
  • I understand that I may withdraw my consent as to use and disclosure of my personal information (except when legal obligations must be met).
  • I am responsible for full payment of account fees, on the day of the consultation.
  • I agree that if I require a Medical Report to be completed, I am liable for the payment prior to it being released, unless otherwise stated.