New Patient Registration

PATIENT DETAILS

SOCIAL HISTORY

RISK FACTORS - Please tick (if it applies to you)

Have you had any operations / procedures / conditions? - Please tick (if it applies to you)

FAMILY HISTORY QUESTIONS

PATIENT DETAILS

SOCIAL HISTORY

RISK FACTORS - Please tick (if it applies to you)

Have you had any operations / procedures / conditions? - Please tick (if it applies to you)

FAMILY HISTORY QUESTIONS

Patient Consent to Collect and Disclose Information

The Privacy Act 1988 requires all health practioners to obtain consent from their patients to collect, use and disclose patient information. We are committed to protecting the privacy information & handling of personal information by the State Privacy Legislation.

Collection

Cardiac Care Centre staff will collect information that is necessary to provide your medical requirements and treatment, including:

  • Full medical and psychological history.
  • Family medical and pshchological history.
  • Gender and Ethnicity
  • Medicare / Private health fund details.
  • Billing and accounting information.
  • Contact Details including Next of Kin details – in case of emargency, we may need to contact your relatives or family

The information will normally be collected directly from you; however, there may be occasions when it will be necessary to collect information from other sources without your prior consent.
These sources may include but are not limited to:

  • Parents about children.
  • Children about their family.
  • Schools and teachers.
  • Treating Specialists; Radiologists; Pathologists; Hospitals, and any healthcare providers

In emergency situations, we may need to contact your relatives or other sources to collect information without your prior consent.

Use and Disclosure

Cardiac Care Centre is commited to treating your personal information as strictly private and confidential. Your information will only be used and disclosed for the purposes directly related to your care and treatment such as:

  • Account keeping and billing.
  • To reply to your referring doctor.
  • Referral to another health care provide or hospital.
  • Management: quality assurance, accreditations, research, and complaint handing.
  • To prevent or lessen a serious threat to an individual’s life, health or safety. Where legally required by a Court, Tribunal, Solicitors, Police, Medicare, etc.
  • To meet our obligations of notification to medical defense organisations or insurer.

Access

You are entitled to have access to your own health records at any time convenient to all parties. We provide your medical to relevant Hospitals and to your GP free of charge, however, should the patient require copies of these records, an administration fee will be payable.
Special reports such as those for Employers, RTA, Centrelink or Immigration incur a private fee and cannot be bulkbilled.
There are some circumstances in which access may be denied, but in such an event you will be advised of the reason. If you find any information we hold on you is inaccurate or incomplete, please advise us so that we can adjust your record. We are not able to erase the original record.

Terms of our Practice

Patient is advised that some or all of our services may be billable and must be paid for at the day of their appointment. It is the patient’s responsibility to check any relevant costs prior to making an appointment.
Any monitors provided to patient on rent are due to be returned in original condition at the time instructed, else late fees are applicable. Any damage or loss of a monitor will incur the full cost of replacement. Patient is responsible for proper care and timely return of monitors.

Patients are obliged to remember appointment times and attend the practice for follow up appointments as per their Doctor’s advice.

While we provide courtesy reminder calls/SMSs, remembering the appointment is solely the patient’s own responsibility.

Should you reschedule or cancel your appointment within 48 working hours of the scheduled appointment, a cancellation fee/s may apply.

The doctor may not always be available to accept phone calls from patients, you may need to attend the practice or Hospital Emergency should your matter be urgent.

Privacy Policy

Patient File – means the whole of the information including contact information, medical records, attachments and any other information relative to the patient.

Patient Record – means the medical record of the patient collected at your 1st appointment by a healthcare professional including history and all information added to the record by treating healthcare professionals.

CCC- means Cardiac Care Centre

You acknowledge your understanding of our Privacy Policy when you submit or complete any form provided to you via CCC’s websites or any persons employed by CCC.

Our Privacy Policy ensures your patient file is maintained with the greatest care for security, accuracy and privacy and that it complies with all current State and Federal Privacy Legislation.

We will not sell or otherwise provide your personal information to a third party or make any other use of personal information for any purpose which is not specifically allowed under this Policy or is not incidental to the normal use of our services.

Your patient file and any information contained in this file, including: contact information, the patient record (medical history) and any relevant attachments cannot be removed from CCC’s secured servers to any other location without written authority, provided by you, to CCC.

After paying your account, we do not retain any Merchant card or payment method information.

Your patient file is created by our reception staff from information you provide on CCC owned forms when you attend your first appointment. Your patient record (medical record or history contained within the patient file) is required to be created and maintained by your treating healthcare professional(s) incorporating all appropriate information to provide a full understanding of your medical history relevant to a medical or health practitioner (example referring doctors, specialists, other healthcare workers).

These records and specific attachments (Doctor Referrals, imaging and diagnostic reports etc.) are the only items in your patient file available to healthcare professionals at CCC. Whilst this part of your file is only available to healthcare professionals, it is jointly owned by the health professionals who create or contribute to the record and CCC and must be maintained for a period of seven years from your last visit to CCC, however none of this information or any contact information can be removed from CCC without your written authority.

Health Records and Information Privacy Act 2002 entitles you to request access to your patient record. Under the Act, CCC is required to see evidence of identity and a written authority from you to copy any information contained in your patient record before providing it to any person or organisation authorised by you. CCC is entitled to charge a reasonable administration fee for providing a copy of any requested information.

Soliciting or in any other way obtaining, copying or downloading your contact information for the purposes of removing it from CCC or removing any other part of your patient file by any person, including management, employees and sub-contractors or any other person provided lawful access to CCC premises, without your written authority sighted by CCC management, to do so, is a breach of the Privacy Act 1998, our Privacy Policy with you and all CCC employment / contractor agreements written or otherwise agreed. All management, employees, healthcare contractors and any other person provide lawful access to CCC are automatically bound by this Privacy Policy when they work for CCC.

All CCC practitioners are also bound by restrictive covenants while working at CCC and for 12 months following termination of their agreements with CCC unless they have otherwise agreed a variation of their agreements with the owners of CCC. These covenants include CCC healthcare professionals no practising within a radius of 10 kms of CCC and not to solicit or persuade any patient who has obtained medical or health services at CCC to follow them to another location or cease obtaining medical or health services at CCC.

Under the guidelines of the Office of the Australian Information Commissioner (OAIC) CCC is required to notify you immediately if there is any breach or suspected breach of your patient file or any part of your patient file. As of March 2014 notification of any breach is mandatory and at the discretion of the Privacy Commissioner CCC and or persons responsible for any breach may be liable to heavy fines by the OAIC (Privacy Amendment – Enhancing Privacy Protection Bill 2012). In the unlikely event a breach or suspected breach occurs notification to you may be by SMS, e-mail or post.

All CCC owned websites and our centre provide forms that may ask you to provide contact information and other information so that we may deal with your health related requirements, queries, online appointments or requests to receive information that is relevant to you. Some non-personal information may be collected, via these forms, to assist CCC manage patient expectations. This information is kept anonymously and with no cross reference to you.

We may use contact information you provide to SMS or e-mail appointment reminders to help prevent you missing appointments.

If you wish to opt out of receiving SMS, e-mail appointment reminders or any other communications, please inform reception.