Patient Registration Form – Dr Rohan Price

if you have ticked Work Cover or TAC please note: Approval of your application is necessary prior to admission to hospital. The TAC or Work Cover will not be liable for the cost of providing treatment to you unless they have confirmed that you are a client and they have accepted liability for your hospitalisation, treatments and other associated costs. If TAC or Work Cover do not accept liability for your hospitalisation, treatments and other associated costs, then you may be admitted under your private insurer.

I understand that this practice handles personal information in accordance with the National Privacy Principles enshrined in the Privacy Act 1988 (Commonwealth) and as outlined in the Privacy Statement. I consent to the handling of my information by this practice for the purpose of providing quality health care, associated administrative and billing purposes, and disclosure for research and quality assurance activities.

I consent to the handling of my information by this practice, including via email, fax and postage, for the purpose of providing quality health care, associated administrative and billing purposes, and disclosure for research and quality assurance activities. We take reasonable steps to protect information and your privacy when transmitting your information, We will use post, secure messaging, facsimile, and email, to transmit your information, on request or as appropriate. You acknowledge that email is not a secure form of transmission. We are unable to provide clinical advice to patients via email.

I also give permission for medical information to be obtained from any other source in order to help with my treatment.