PLEASE COMPLETE THIS FORM within seven days of a new patient appointment offer
The requested information is necessary for contacting you, triaging, billing, Medicare, prescriptions, privacy and other clinical care.
Staff will not be asked to enter the form into your file at the last minute if time is not available. Prosper Paediatrics will not be responsible for the consequences to you of your late provision of needed information.
Completion of this Demographic Form and the Consent to Policies Form are required to accept a New Patient Appointment Offer. If these are not completed within seven days, we will understand that you are declining the Appointment Offer, and we will withdraw the Appointment offer, close your child’s intake and remove them from the Patient Waiting List.
This form is required for New Patients or previous or continuing patients who have not been seen by any associated provider for several years.
Please complete the Patient Demographic Form below
if a New patient or
if your details have changed (e.g., parenting, address, phone numbers, GP).
You can also download the form to printout, complete and send it in via post or email, or ask our receptionists to post or email the form to you.
My Health Record (myHR)
Clinicians in the practice may have access to the My Health Records (myHR) of their patients, if the patient (or their parent/guardian) has not already opted out of having a My Health Record.
Your doctor may therefore view and/or upload to the patient’s My Health Record, unless you ask them not to.
The patient or parent/guardian may:
Ask the doctor not to upload documents/other information to the My Health Record.
Ask the doctor to delete something they previously uploaded.
Set their own privacy and security controls on the My Health Record through myGov. This may include setting a security code to prevent a doctor accessing the myHR unless you provide the code (unless it is an emergency situation).
Delete documents/records from the myHR through MyGov.
Parents can manage their child’s myHR until their child turns 14, at which point their access to their child’s record will be removed. Children aged 14-17 can specially nominate their parents to have access to their myHR if they wish.