Patient Information and Consent

Patient Information and Consent Form

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Privacy Notice

CRT may disclose personal information to your Referring doctor, and/or other health providers to assist in providing medical treatment to you. We may also need to obtain medical records from your doctor and/or other health providers in order to assist in your diagnosis and/or treatment. In some circumstances we are required by the law to disclose your personal information eg in response to a Court Subpoena.

Your Imaging Report and other health information may be disclosed by us for the use of teaching Medical Students. If this is done, all necessary steps will be undertaken to de-identify you so that it is not apparent that the imaging/report and health information belongs to you.

I give my consent for disclosure of my records for research and quality assurance activities to improve individual and community health care and practice management. This may occur when the practice incorporates patient health records into de-identifiable patient information transfer to a third party, normally used for research and quality improvement projects. De-identified patient information can not be traced back to the individual.

CRT will destroy or de-identify any personal information after its legal obligations to retain the information has expired.

In the event that this claim is rejected by Medicare/ Department of Veteran Affairs or your Private Health Fund, I authorise CRT to issue an account in my name at the Private Fee rate.

By signing below, I hereby authorise CRT to obtain from and/or release to relevant parties all medical records relevant to my treatment/ diagnosis.

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