If you or your loved one require emergency support, please call 000.
PLEASE ENSURE YOU BRING ALL REPORTS TO YOUR CONSULTATION
This gathering of information is a necessary part of the assessment, diagnosis, and treatment procedure, and is seen only by the Clinician. All personal information gathered by the clinician during the provision of the service will remain confidential and secure within the practice except where:
Authority to Release information
By signing this form, you are giving Educational Case Management Pty Ltd (ECM) consent to obtain relevant medical records, reports and/or statements from your treating medical practitioner, allied health professional and/or other professional persons involved in your care. The purpose of collecting this health information is to assist ECM practitioners in supporting you and determining ‘best practice’
As part of providing a service to you, Educational Case Management Pty Ltd - Psychology, Occupational Therapy and Speech Pathology, needs to collect and record personal information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information as part of providing psychological services to you.
This collection of personal information will be a necessary part of the assessment and treatment that is conducted.
Purpose of collecting and holding information
Your personal information is gathered as part of your assessment and treatment, is kept securely and, in the interests of your privacy, used only by your psychologist and the authorised personnel of the practice (as necessary). Your personal information is retained in order to document what happens during sessions and enables the psychologist to provide a relevant and informed psychological service to you.
Consequence of not providing personal information
Access to client information
At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. The Clinician may discuss with your different possible forms of access.
Disclosure of personal information
All personal information gathered by the clinician during the provision of the allied health service will remain confidential except when:
it is subpoenaed by a court; or
failure to disclose the information would in the reasonable belief of the (Educational Case Management) place you or another person at serious risk to life, health or safety; or
your prior approval has been obtained to
provide a written report to another professional or agency. e.g., a GP, NDIS or a lawyer; or
discuss the material with another person, e.g. a parent, employer or health provider; or
disclose the information in another way; or
you would reasonably expect your personal information to be disclosed to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected; or
Unfortunately, we need to charge a cancellation fee if you do not attend an appointment, or if you need to cancel after 3pm on the day prior to scheduled appointment. We have a wait list; hence your appointment could be allocated to someone else if we have enough notice. Please refer to the Cancellation Policy on our website.
By signing this form, you have read, understood and agreed our terms and conditions, privacy and authority to release information.
If after reading this form you are at all unclear about any of the information provided, please contact the psychologist prior to your appointment
Initial Appointment - $250Initial Appointment Concession - $185Multidisciplinary Reports - $750All Therapy Consultations - $185All Concession Consultations - $130
Health Fund and Medicare Rebates apply
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OfficeUnit 3, 56 Hudson St, Hamilton NSW 2303
Phone(02) 4969 8060