CONSENT TO COLLECT PATIENT INFORMATION & FOR DIAGNOSTIC TESTING, AS REQUIRED
This medical practice collects information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and medical history so that we may properly assess, diagnose, treat and be proactive in your health care needs.
By signing this form, you consent to undergo diagnostic testing carried out at Penrith Cardiology. Testing may include heart echo/ultrasound, Exercise stress testing, and all blood pressure and heart monitoring. Results will be forwarded to your referring physician and other healthcare professionals, which you may nominate.
The information you provide us with will be used for 1) administrative purposes in our medical practice, 2) for billing purposes (including compliance with Medicare and Health Insurance Commission requirements).
I understand the reasons why my information must be collected. I understand that I am not obliged to provide any information requested of me, but my failure to do so might compromise the quality of the health care and treatment given to me. I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand that if my information is to be used for any purpose other than the above, my consent will be sought.
By submitting this form, you are providing your electronic signature and consent.
