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Privacy Consent Form

Privacy Consent Form

The QUFW Group, which comprises QUFW, QUFW Brisbane, QUFW Southport and QUFW Tugun (we, us, our), requires your consent to allow us to use and collect your personal information to provide you with the best possible healthcare. It is important that you read this form, as it relates to how we deal with your personal and health information.

We collect your information for the purpose of providing quality healthcare. Accordingly, we require your personal details and a full medical history so that we may properly assess, diagnose, treat you and be proactive in your health care needs. If you do not provide this information we may be unable to treat you.

By signing below you agree to us:

  • collecting your personal information;
  • obtaining your medical file from Queensland Ultrasound for Women (if any);
  • using your information as set out in this form and our Patient Privacy Policy; and
  • disclosing your information to others involved in your health care, including to other doctors practicing as part of the QUFW Group.

There may be occasions where the law allows or requires us to use or disclose your personal information without your consent and examples of such situations are contained in the Patient Privacy Policy (available on our website and at reception).

If you have any questions in relation to any of the above matters please raise these with your doctor.

  • As part of our practice, we conduct research and teaching. In the event we wish to use your medical information for research or teaching purposes, we will de-identify your personal information (i.e. the information no longer identifies you or is reasonably capable of identifying you).

  • We place an emphasis on meeting high clinical standards. In order to consistently achieve these high clinical standards, we audit our performance which involves requesting information about the case outcome from our medical colleagues (e.g. a hospital).

  • I acknowledge that I have read and understand this form before checking the box below and that I have been given the opportunity to read QUFW’s Patient Privacy Policy. I understand that:

    • I can request for my information to be corrected if I believe it is inaccurate;

    • I am not obligated to provide any information requested of me, but that my failure to do so might compromise the quality of the health care and treatment given to me.

    • I have a right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances; and

    • If I request access to information about me, the practice will be entitled to charge me fees to cover: the time spent by administrative staff to provide access at the employee’s hourly rate of pay, time spent by a medical practitioner to provide access at the practitioners ordinary sessional rate, and for other disbursements.