I understand the following:
Access to my health information
I have the right to access (and have corrected)
my health information under Rules 6 and 7 of the Health Information Privacy Code 1994.
Visiting another GP
If I visit another GP, outside of QMC, who is not my regular doctor I will be asked for permission
to share information from the visit with my regular doctor or practice.
If I have a High User Health Card or Community Services Card and I visit another GP outside of QMC,
who is not my regular doctor, he/she can make a claim for a subsidy, and the practice I am enrolled
in will be informed of the date of that visit. The name of the practice I visited and the reason(s)
for the visit will not be disclosed unless I give my consent.
Patient Enrolment Information
The information I have provided on the Practice Enrolment Form will be:
• held by the practice
• used by the Ministry of Health to give me a National Health (NHI number, or update any
• sent to the PHO and Ministry of Health to obtain subsidised funding on my behalf
• used to determine eligibility to receive publicly-funded services. Information may be
compared with other government agencies but only when permitted under the Privacy Act.
Members of my health team may:
• add to my health record during any services provided to me and use that information to
provide appropriate care
• share relevant health information to other health professionals who are directly involved in
In the case of financial audits, my health information may be reviewed by an auditor for checking a
financial claim made by the practice, but only according to the terms and conditions of section 22G
of the Health Act (or any subsequent applicable Act). I may be contacted by the auditor to check
that services have been received. If the audit involves checking on health matters, an appropriately
qualified health care practitioner will view the health records.
Health data relevant to a programme in which I am enrolled (e.g. Breast Screening, Immunisation,
Diabetes) may be sent to the PHO or the external health agency managing this programme.
Other Uses of Health Information
Health information which will not include my name but may include my National Health Index
Identifier (NHI) may be used by health agencies such as the District Health Board, Ministry of
Health or PHO for the following purposes, as long as it is not used or published in a way that can
• health service planning and reporting
• monitoring service quality
My health information may be used for health research, but only if this has been approved by an
Ethics Committee and will not be used or published in a way that can identify me.
Health Information to Private Insurers
I understand that where the cost of service(s) provided by my doctor and/or nurse have been or will
be claimed from a private health insurer that QMC may be required to provide the insurer with
details of the consultation(s) and/or procedure(s) relating to the claim(s) if so requested by the
insurer. I hereby consent to QMC providing this information to such private health insurers.
By agreeing to receive emails or text messages for requests, invitations and notifications and to
participate in health programmes relating to your on-going health care, QMC will not, without your
express instruction email or text any results information. By consenting to us emailing or texting
any information, you accept full responsibility for logical and physical security of your email and
text system and for notifying us of changes to your email address or mobile phone numbers.
Consequently QMC disclaim any responsibility or liability and you agree to indemnify us for
unauthorised access to your email or text messages or unauthorised viewing of information sent by
us. By signing this enrolment form you are acknowledging your responsibilities.
Except as listed above, I understand that details about my health status or the services I have
received will remain confidential within the medical practice unless I give specific consent for
this information to be communicated.
By signing the QMC PHO enrolment form, or by completing the casual/visitor details form, the patient agrees to these terms of trade.