Patient Consent to Collect & Disclose Information

Patient Declaration & Understanding

Before signing, patients must confirm they have read and understood the form contents, had opportunity to ask questions, and voluntarily consent to collection, use, and disclosure of personal information as outlined.

Collection of Personal Information

In accordance with the Privacy Act 1988 (Cth) and Australian Privacy Principles, the practice collects:

• Personal details including name, date of birth, contact details, Medicare and private health insurance information
• Medical history covering previous and current conditions, medications, allergies, family medical history, and genetic information
• Billing and account details for consultations and treatments

Information is gathered from patients directly via consultations or forms, from other healthcare providers including general practitioners and specialists, and from family members or carers in medical emergencies.

Use & Disclosure of Information

Information is used in compliance with privacy legislation for:

• Treatment coordination, including sharing medical information with other practitioners, pathology and radiology services
• Practice management covering appointment scheduling, billing, regulatory compliance, quality assurance, and accreditation
• Legal and insurance obligations including court orders, subpoenas, mandatory reporting of child abuse or communicable diseases, and disclosures to medical defence organisations

Participation in Surgical Audits (Optional)

The surgeon participates in peer-reviewed surgical audits assessing outcomes and improving patient care. Data used in audits is de-identified and cannot be traced back to individual patients. Non-participation will not affect medical care. Patients declining should inform reception staff upon arrival without signing consent.

Participation in AI-Assisted Medical Documentation

The practice uses AI-assisted documentation technology to improve accuracy and efficiency during consultations, allowing the surgeon to focus more on patient discussion.

How It Works

AI transcribes dialogue in real time during consultations. No audio recordings are stored. The surgeon reviews and finalises the written summary before it becomes the medical record. Summaries are used internally and for generating referral letters.

Data Security & Privacy

The practice commits to protecting personal information under privacy legislation. Transcriptions are deleted after summary generation.

Opt-Out Option

Patients declining AI-assisted documentation should not sign the form and inform reception upon arrival. Manual note-taking will be used instead. Consent may be withdrawn at any time via written request by email or letter.

Accuracy & Corrections

The surgeon reviews and finalises AI-generated notes. If errors are detected by patients or referring doctors, the practice should be notified promptly. Confirmed corrections are documented and sent to relevant parties.

Access to Your Medical Records

Patients have rights to access medical records under privacy and health records legislation. Access may be denied or restricted where providing access would pose serious threats to life, health or safety; relates to anticipated or ongoing legal proceedings; would unreasonably impact another person’s privacy; or involves national security or law enforcement concerns.

Access requests must be made in writing. Administrative processing fees may apply. Patients may request amendments to incorrect information. The practice will record corrections but will not erase original records.

Financial Consent

This is a private practice. Patients are responsible for all consultation fees, which are not fully covered by Medicare. Patients requiring surgery must verify their private health fund coverage.

Email Communication & Security

The practice may use email for medical information directly related to patient care. However, email is not fully secure and carries risks of unauthorised access. While the practice takes reasonable protective measures, it cannot guarantee absolute security.

Patients declining email communication should not sign the form and inform reception upon arrival. Alternative methods including phone calls, mail, or secure patient portals will be used instead.