- I intend to use this practice as my regular and on-going provider of general practice/GP/healthcare services.
- I understand that by enrolling with this practice, I will be included in the enrolled population with the Primary Health Organisation (PHO) this practice belongs to, and my name, address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers.
- I understand that if I visit another health care provider where I am not enrolled, I may be charged a higher fee.
- I have read and I agree with the Health Information and Privacy Statement. The information I have provided on the Enrolment Form will be used to determine eligibility to receive publicly funded services. Information may be compared with other government agencies, but only when permitted under the Privacy Act.
- I understand that to support the provision of the best possible care, we may receive information about you from other agencies, either directly or indirectly.
- I understand that if I provide information about another person as part of the enrolment process, e.g. next of kin, children, that I am responsible for informing them and obtaining their consent to do so. We will assume this consent has been obtained upon signing of this enrolment form.
- I understand that the practice participates in a national survey about people’s health care experience and how their overall care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the survey. The survey provides important information that is used to improve health services.
- I understand that the practice’s healthcare team may use AI tools for clinical documentation. All AI-assisted work is reviewed with human oversight to ensure their accuracy and appropriateness. AI will not be used for clinical decision-making or judgment. All health information will be used in accordance with legislative requirements and will not be shared with AI systems outside the practice without consent. All data processed by AI clinical documentation tools will be handled securely and in compliance with data protection regulations. You will be informed about how AI tools are being used at our practice and can ask questions or request more information at any time. You can also withdraw your consent at any point by notifying the practice.
- I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.
- I agree to the practice collecting, using and sharing my personal and health information as outlined in the Health Information and Privacy Statement and The Doctors Privacy Policy
- I understand that this practice is entitled to charge a fee for the health services it provides and that I agree to pay such costs according to the policy of practice, including any additional costs associated with the collection of overdue or unpaid accounts.
