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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






I (participant/carer/guardian), hereby provide my informed consent to participate in the NDIS audit conducted by (NDIS Approved Quality Auditor).

 I understand and acknowledge that the purpose of this audit is to assess and evaluate the quality and effectiveness of the services provided to NDIS participants like myself. 

The audit will involve reviewing relevant documentation and conducting interviews with the participant, their carers, and relevant staff members. 

The information obtained during this audit will be used solely for the purposes of evaluating the services and compliance with NDIS requirements.

I understand that my participation in the audit is voluntary and that I have the right to withdraw my consent at any time without providing any reason. My decision to participate or withdraw my consent will not affect my current or future access to NDIS services or support delivered by Capaz Health. Additionally, I understand that my decision to participate or not participate will be respected and will not impact the quality of the services provided to me.

I acknowledge that my personal information, including my name, address, NDIS number, and other relevant details, may be collected, used, and disclosed by Capaz Health solely for the 6 purposes of conducting the NDIS audit.

I understand that the information collected during the audit will be handled in accordance with applicable privacy laws and regulations.

I agree that the findings and outcomes of the NDIS audit may be shared with relevant NDIS authorities, including the National Disability Insurance Agency (NDIA), for the purpose of compliance monitoring and improving service quality within the NDIS framework. However, my personal information will be de-identified or anonymised when shared externally to ensure my privacy and confidentiality.I have had the opportunity to ask questions and seek clarification regarding my participation in the NDIS audit, and all my questions have been answered to my satisfaction. 

I have read and understood the contents of this consent form and voluntarily provide my consent for inclusion in the NDIS audit.

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  • Po Box 215 Port Macquarie NSW 2444
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