Consent for Video Telehealth Services:

You understand that your medical consultation with your health practitioner will be conducted via video and/or audio telehealth. You acknowledge the potential differences between traditional in-person health services and telehealth, including but not limited to privacy and security risks associated with electronic communication. You confirm that you prefer a telehealth appointment and understand the processes involved, including proposed treatment, sharing of information with others in your care team, and providing consent if the consultation is being recorded .

Right to Withdraw Consent:

You understand that you have the right to withdraw this consent at any time by notifying your healthcare provider in writing.

Acknowledgment of Technology Platform:

You confirm that you have access to the necessary technology platform for telehealth services, which provides adequate audio and video quality and meets security and privacy standards. You are confident in your ability to use this platform.

Risk Management:

You understand that risk mitigation strategies are in place to address potential risks to your mental or physical health during telehealth consultations. You acknowledge that your healthcare provider will confirm your location and who else is present at the start of each session.

Communication Methods and Security:

You consent to receive communication related to your telehealth services and injury management via email, text, or phone call and in accordance with our Privacy Policy. You understand that all efforts are made to keep your information secure in these communications.

Your privacy and medical records

In accordance with section 6(1) of the Privacy Act 1988 (Cth) (“ Privacy Act”), all information collected in the video and/or audio telehealth consultation is treated as ‘sensitive information’. To protect your privacy, Legion Health operates in accordance with the Privacy Act and its Privacy Policy. A copy of our Privacy Policy is available free of charge on our website at www.nimsolutions.com.au and can be provided by your health practitioner at any time on request.

Your health practitioner uses the information you provide to manage your health care, which may include using the information for the following purposes (including instructing Legion Health to use the information for the following purposes on your health practitioner’s behalf):

Collecting, recording and storing your personal and health information that will form part of an individual computerised medical record.

For the purpose of making referrals to other health specialists (including through the use of third party databases).

Issuing reminders for specific health checks that you may require, if any, as part of your telehealth consultation with your health practitioner.

Providing you with health information updates, general medical updates and provide your personal and health information to the relevant state and/or national recall reminder registers.

Using your personal and health information to undertake, however not limited to; administrative tasks involved in the running of Legion Health, and for your health practitioner, billing tasks which includes compliance with Medicare, Health Insurance Commission and other relevant Government agency requirements.

You can assist in maintaining the accuracy of your information by advising your health practitioner of changes in your contact details.

Selected information may be disclosed to various other health care providers involved in supporting your health care management (e.g. pathology and imaging providers, hospitals or other specialists). You hereby acknowledge and consent to the disclosure and/or use of your personal health information by Legion Health, your health practitioner and persons directly or indirectly involved in your personal health care or medical treatment for that purpose, including:

Sending personal information to third party services as part of your practitioner providing referrals to specialists who will be involved in your further care;

Disclosing your personal and health information to the relevant medical and allied health service providers involved in your care.

Disclosing de-identified personal and health information for research and quality assurance purposes undertaken by your health practitioner to improve the quality of both individual and community health care needs and medical practice management. Legion Health will inform you when such activities are being conducted and give you the opportunity to ‘opt-out’ of any involvement at any time.

Using your personal and health information by your health practitioner and other authorised individuals involved in your medical care and treatment, both directly and indirectly.

Disclosing for legal related purposes as requested and required by a court or other regulatory body.

For medical training/teaching purposes where de-identified information is disclosed to medical students and staff.

For disease notification as required by the law.

Where your treatment relates to a workplace or work-related injury and you see your health practitioner in relation to this injury at the request of your employer, selected information may be disclosed to your employer (or any authorised representative of them) to facilitate your ongoing care and accommodations including return to work arrangements.

You are not obliged to provide information requested of you, however your failure to do so may compromise the quality of care provided to you by your health practitioner.

You understand your right to access both your personal and health information held by Legion Health, except in circumstances where access is legitimately withheld. If your personal and health information is to be used for any other purpose, other than what is set above, your further consent will be obtained.

You understand it is your responsibility to inform Legion Health at the earliest of any changes to your personal and health information. If any information held about you is inaccurate, you may request to have this altered accordingly.

You hereby acknowledge and consent to the disclosure and/or use of your personal health information by Legion Health on your health practitioner’s behalf and persons directly or indirectly involved in your personal health care or medical treatment for the purposes set out above.

If you have any questions regarding the management of your personal health information or need to arrange to access to your records, please ask Legion Health or your health practitioner, as appropriate.

Please sign this form as confirmation that you have read, understood and consent to the use of your personal and health information as stated above.

If you do not wish for this to occur, please advise Legion Health during your appointment .