beyonddisabilitysupport
Personal information collection, holding, use and disclosure of personal information by this organisation is protected by the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) (Privacy Act).
Personal information is any information or an opinion that identifies you or could identify you and includes information about your health.
The purpose for collecting personal information from you is to:
provide services, including planning, coordinating, funding, implementing, monitoring and reviewing our services
report to NDIS, government or other funding bodies of how funding is serviced by us,
take photographs and videos for therapeutic and marketing purposes
responding to your feedbacks, and
responding to your queries.
Please note that BDS is required to release information about service users (without identifying you by full name or address) to the Disability Services Commission and to the Australian Institute of Health and Welfare, to enable statistics about disability services and their participants to be compiled. The information will be kept confidential. This information is used for statistical purposes only and will not be used to affect your entitlements or your access to services. As a user of National Disability Agreement services you have the right to access your own files and to update or correct information included in the Disability Services National Minimum Data Set collection.
This organisation will not disclose/use information about you for any secondary purpose unless:
You have consented to the use or disclosure; or
You would reasonably expect us to use or disclose the information for the secondary purpose as it is directly related to the primary purpose; or
The use or disclosure of the information is required or authorised by or under an Australian law or a court/tribunal order; or
Our organisation reasonably believes the use or disclosure is necessary to lessen or prevent a serious threat to life, health or safety of an individual or to public health and safety; or
Our Organisation has reason to suspect an individual may have done something unlawful or engaged in serious misconduct that relates to organisational functions or activities;
Our organisation reasonably believes that the use or disclosure is reasonably necessary to assist another person to locate a person reported as missing.
Use of Media I do not give the organisation authority to use photographs and videos for therapeutic purposesI do not give the organisation authority to use photographs and videos for marketing purposes.I do not give the organisation authority to send me information about services via a NewsletterI do not give the organisation authority to contact me to advise me of service related opportunities
I give authority to Beyond Disability Support to collect, store, use and disclose personal and sensitive information, including health records, for the primary purpose of service provision and directly related needs in accordance with the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) whilst I/we remain a participant of this organisation.
If my circumstances change, I agree to notify Beyond Disability Support as soon as practicable.
Participant's Name
Date
Your Name (if different to Participant)
Relationship to Participant
Note: Where a participant does not have the capacity to give informed consent and does not have a legal guardian who has the authority to make decisions on behalf of the participant, the participant’s parent, family member or other person with a close personal relationship to the participant may sign this form. The person who signs on the participant’s behalf must print their relationship to the participant next to their name.
Signature
Pursuant to The Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) and The Health Information Protection Act
The purpose of this form is to provide consent to the release of personal information to third parties as requested by the Participant which is protected and governed by the privacy provisions of The Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) and The Health Information Protection Act.
Address Line 1
Address Line 2
City
State / Province / Region
Consent release to
Contact Information
Personal information which the organisation, or its staff need to release in order to respond to the following concern or issue:
I understand this may include personal information within the meaning of The Freedom of Information and Protection of Privacy Act, and personal health information within the meaning of The Health Information Protection Act.
I further understand that the organisation will only release as much information as is needed to respond to my concern and subject to the restrictions and provisions of The Freedom of Information and Protection of Privacy Act 2012 (Cth) and The Health Information Protection Act.
Person Consenting to Release
Email
Signature of Person Consenting to Release
In order to comply with privacy legislation, this consent is necessary when participants ask third parties to either advocate or make inquiries on their behalf regarding various issues or services provided by the organisation.
In all cases, the organisation will only release as much information as is needed in order to respond to the inquiry or participant’s concern.
Certain information will not be released by the organisation e.g. information about other individuals, records subject to solicitor-participant privilege, records relating to a current lawful investigation, records the release of which would affect the safety or health of anyone).
In the event a subsequent inquiry is made by the same third party which is unrelated to any previous participant concern, another consent form will need to be completed.
