ConsentForm

Dear AICA TEST,

Regarding your therapy service with MobiHealthcare, at

Privacy Notice

We are committed to protecting the privacy of your personal information and health information in accordance with the Privacy and Personal Information Protection Act 1998 (PPIP Act) and Health Records and Information Privacy Act 2002 (HRIP Act).

We collect personal and health information to fullfill our legal obligation of file notation. Such information may include:

• Name, age, gender;
• Whether your child has any health issues, medical issues or disability;
• Other related information received in the course of providing the Services; and
• A summary of the therapy session.

We will not disclose your child’s personal and health information to third parties unless authorised by law or by consent. The below is a consent form to allow relevant information to be shared with your child’s school (‘School’), NSW Department of Education (‘Department’), to arrange appropriate supports for your child whilst at School or engaged in school related activities.

Consent form

I understand:

• Mobihealthcare therapists may collect the information described above, which includes information about the nature and implications of my child’s medical condition;
• this information may be disclosed to the School;
• the purpose of the information being disclosed is for the School to consider and arrange supports that are relevant for the child during school hours and school-related activities;
• the information given may be discussed by the principal of the School with other members of the Department with relevant expertise, as is necessary, enabling to care for the child;
• the School will not disclose this information to third parties other than in accordance with the School’s legal obligations or permitted by law;
• as a parent/carer, I may contact the Mobi healthcare or School to seek the information provided by Mobihealthcare
• the information will be held by the Mobihealthcare and the School in accordance with their respective guidelines and legal obligations for the holding of information.