Client
Consent Form
Due
to changes in legislation regarding Privacy Information, all Health Service
providers are required to give written advice to clients about the information
kept about them and how they can access this.
These details are common, professional practice and part of our duty of
care to you. Please read this
carefully, and then sign and date the attached form.
Client
Information
When
making an appointment with Karinya, and again at your initial consultation, you
will have provided certain information about yourself for our records (such as
name, address, contact details and any other relevant information).
This information is recorded on a database, protected by a password and
is available only to key staff in the organization, such as the office manager.
This information remains active as long as you are a client at the
centre, after which time it is archived. You
are not required by law to provide the personal information requested.
However, the details you provide:
Assist
us to give you the highest possible standard of care,
Help
us to identify your record at a later date should we need to do so at your
request,
Assist us to provide the best possible service.
Please
advise the office manager of your centre should your details change in order for
us to update these.
Client
Records
In
addition to the information provided in your initial contact, all communication
between you and the counsellor becomes part of a clinical record to enable the
counsellor to make informed decisions regarding assessment, diagnosis, and the
best possible treatment. Karinya
keeps a hard copy of your records in a locked filing cabinet accessible only to
the counsellor whilst you are a current client and afterwards by those delegated
to archive the information. Records
are kept for 7 years beyond the date of the last session, and in the case of
minors, until they attain 25 years of age. If
at any time you wish to have access to your record, please speak to either your
counsellor or the office manager. Your
record will be made available for you to discuss with your counsellor (or
another counsellor if the relevant counsellor is no longer available). You will
require an appointment to do so and an appropriate cost will be charged.
If
there are circumstances under which your information may be shared with another
professional (or by another professional with your counsellor), only information
relevant to your ongoing care will be discussed.
You will also be asked to sign a specific form to enable this to occur.
This form will be stored in your Record.
No information about you will be shared with another party unless you
have first been consulted with exception of the conditions outlined in the
Client Information sheet.
Concerns
If you have a concern about
the management of your personal information, please inform your counsellor.
If you have a complaint or suggestions about the service, and are unable
to speak with the counsellor, contact the Senior Counsellor at the centre you
attend. You are welcome to obtain a
copy of the National Privacy Principles, describing your rights and how your
information should be handled. If
you wish to lodge a complaint about the use of, or access to your personal
information, you may do so with the Office of the Federal Privacy Commissioner
on 1300 363 992 or GPO
By
your signature on the attached form, you are indicating that you have read and
understood this document, and that any questions you have had about any
statements made, have been answered to your satisfaction.
KARINYA COUNSELLING CENTRE CONSENT FORM
I/We,_____________________________
understand the information in the Consent Form.
(print name)
I/We
agree to these conditions for the service provided by Karinya Counselling Centre
Inc.
Signature
__________________________________
Date__________________
Client/guardian
(please circle)
Signature
__________________________________
Date____________________
Client