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Participant Consent Form

PERSONAL INFORMATION

Personal information collection, holding, use and disclosure of personal information by Capaz Health is protected by the Privacy Act 1988 (Cth), Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) and Privacy and Personal Information Protection Act 1998 (NSW) and the Health Records and Information Privacy Act 2002 (NSW). Personal information is any information or an opinion that identifies you or could identify you and includes information about your health.
The purpose of collecting personal information from you is to:
• Providing our services, which may include, but are not limited to, planning, coordinating, implementing, monitoring and reviewing the services to be provided to you.
• Report to the NDIS Commission or other funding bodies on how funding is serviced by us.
• Take photographs and videos for therapeutic and/or marketing purposes.
• Responding to your feedback and complaints, and
• Responding to your queries.
Capaz Health 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
• Capaz Health reasonably believes the use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of an individual or to public health and safety; or
• Capaz Health has reason to suspect an individual may have done something unlawful or engaged in serious misconduct that relates to Capaz Health’s functions or activities;
• Capaz Health reasonably believes that the use or disclosure is reasonably necessary to assist another person in locating a person reported as missing.

Change or Take Away Consent
If you want to change or take away consent at any time, please contact us by phoning 0427 145 001 or email [email protected]
This includes if you want to:
• Change who has consent
• Change how long you want consent to last 
• Change what types of consent you’ve given  
• Take away consent and do things by yourself
If you choose to change or take away consent, Capaz Health will not rely on your past consent for any future use or disclosure of your personal information.

Participant Consent Form

Participant Details


Use Of Media

Participant Consent for Third Party Release of Information

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 another person with a close personal relationship to the participant may sign this form.
Consent to Participate in NDIS Audit

Signature



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Contact Us

  • Po Box 215 Port Macquarie NSW 2444
  • 0427 145 001
  • [email protected]
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