Registration and Consent

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Consent

I,


, as the of provide consent for Pennant Hills Day Surgery to collect my/the patient's personal and health information on behalf of the various clinicians practicing at Pennant Hills Day Surgery. I consent to Pennant Hills Day Surgery and the clinicians to use and disclose my/the patient's personal and health information for the following purposes:

1. Collection of Personal Information
Pennant Hills Day Surgery collects your personal information and in particular your health information to provide you with a quality health service. The information will normally be collected directly from you. In emergency situations we may need to collect personal information from relatives or other sources where we are unable to obtain your prior consent.

2. Use of Personal Information
Health information is used by the hospital to provide treatment and care, to recover costs from Health Funds and other Insurance Agencies, in quality assurance and clinical audit and evaluation activities, for management, service monitoring, training and education, complaint handling and accreditation activities.

3. Disclosure of Personal Information
Pennant Hills Day Surgery is required by law to provide State and Commonwealth Health Department with data regarding episodes of care, treatment and as required diagnosis of a communicable diseases. Pennant Hills Day Surgery is also legally required to provide Health Funds with information about their clients who attend the hospital.

4. Privacy Questions/Complaints
Any questions about personal information handling practices, or any complaint regarding treatment of your privacy by Pennant Hills Day Surgery can be made in writing addressed to:

    General Manager, Pennant Hills Day Surgery, 361 Pennant Hills Rd, Pennant Hills NSW 2120



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