Client Confidentiality Form

As part of providing a psychological assessment and/or treatment to you (or your child), Dr Rowland (Kids@Heart) will need to collect and record personal information from you that is relevant to your (or his/her) current situation. This information will be a necessary part of the psychological assessment and treatment that is conducted. If you do not wish to provide your personal information, Dr Rowland may not be in a position to provide the psychological service to you.

The psychological service provided is bound by the legal requirements of the Australian Privacy Principles set out in the Privacy Act 1988 (Cth).

Client files are held in a secure filing cabinet and password protected client management software which is accessible only to authorised employees. The information on each file includes personal information such as name, address, contact phone numbers, medical history, and other information which is relevant to the psychological service being provided.

A clients personal information is collected in a number of ways during psychological consultation with Dr Rowland, including when the client provides information directly to Dr Rowland using hardcopy forms, correspondence via email, when the client interacts directly with Kids@Heart employees such as the receptionist, and when other health practitioners provide personal information to Dr Rowland, via referrals, correspondence and medical reports.

The information is gathered as part of the assessment, diagnosis and treatment of the clients condition, and is seen only by Dr Rowland and authorised personnel of the clinic (as necessary). The information is retained in order to document what happens during sessions, and enables Dr Rowland to provide a relevant and informed psychological service.

At any stage the client may request to see the information kept on file. As a client you are entitled to access to the information, unless the relevant legislation provides otherwise. Dr Rowland may discuss the contents with you and/ or give you a copy, subject to the exception in the Privacy Act 1988 (Cth). If satisfied that personal information is inaccurate, out of date or incomplete, reasonable steps will be taken in the circumstances to ensure that this information is corrected. All requests by clients for access to personal information held about them should be lodged with Dr Rowland. These requests will be responded to in writing within 30 days and an appointment will be made if necessary for clarification purposes.

If you have a concern about the management of your personal information, please inform Dr Rowland. Upon request you can obtain a copy of the National Privacy Principles, which describe your rights and how your information should be handled. Ultimately, if you wish to lodge a formal complaint about the use of, or access to, your personal information, you may do so with the Office of the Australian Information Commissioner on 1300 363 992, or GPO Box 5218, Sydney, NSW 1042.

All personal information gathered by Dr Rowland during the provision of the psychological service will remain confidential and secure except where:

1. 1. It is subpoenaed by a court; or
2. 2. Failure to disclose the information would in the reasonable belief of Dr Rowland place you / your child or another person at serious risk to life, health or safety; or
3. 3. Your prior approval has been obtained to:
   •   a) provide a written report to another professional or agency. e.g., a GP or a lawyer; or
   •   b) discuss the material with another person, eg. a parent, educational contact, health provider; or
   •   c) disclose the information in another way; or
4. 4. You would reasonably expect your personal information to be disclosed to another professional or agency (e.g., your GP, paediatrician) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected; or
5. 5. Disclosure is otherwise required by law.

The fee schedule and rebate options are outlined in the information pack located in the client portal (on the website). Dr Rowland will advise you of the consultation fee at the end of each session. Kids@Heart will hold your credit card details securely on file and the session fee will be charged within 48 hours of the consultation by the Kids@Heart administration team. If your consultation session attracts a Medicare rebate Kids@Heart will automatically process your claim. You will receive a receipt via email.

It is understood that sometimes cancellations cannot be avoided. However late notice means that Kids@Heart is unable to offer the appointment to somebody else. As such, a cancellation or non-attendance fee is applicable. Please provide more than 24 hours notice if you need to cancel or change an appointment. Kids@Heart request that notification is made by email to admin@kidsatheart.com.au. Cancellations with less than 24 hours notice will incur a charge of 50% of the scheduled fee. Clients who fail to attend without prior notice will be charged the full scheduled fee.

Dr Rowland will routinely audio or video record diagnostic assessments. This is to aid in the provision of high quality assessment, care and treatment. The recording will be kept on file until the episode of care concludes.