Health Information Consent Form
1. Collection and disclosure statement
Your health information includes any information or opinion about your health, including (but not limited to) any illness, disability or injury, any health service provided (or to be provided) to you, any genetic information about you in a form that is, or could be, predictive of your health, and any other personal information collected to provide, or in providing, health services to you. Stella must not collect or disclose your health information, without your consent.
In the course of conducting our business, Stella Centre Pty Ltd ACN 648 839 525 (Stella or we, us or our) collect, hold, use and disclose your health information, in accordance with this Health Information Consent Form, and our Privacy Policy. This Health Information Consent Form is used to confirm that you consent to Stella collecting and disclosing your health information.
You can withdraw your consent at any time by contacting Stella via management@stellacentre.com.au. However, please note that if we cannot collect, use or disclose your health information as contemplated in this Health Information Consent Form, then it is likely that we will not be able to provide our services to you.
Please read this Health Information Consent Form and our Privacy Policy (see Section 4 below) carefully and in full. You agree that a copy of this Health Information Consent Form will be valid and effective, where you have signed physically, signed electronically or indicated your consent by way of a tick box (“acknowledgment”) on our website or consented verbally.
2. How we collect, use, and disclose your health information
By indicating your consent in accordance with this Health Information Consent Form, you authorise Stella to collect, use and disclose your health information as follows:
- collect your health information when you complete our PTSD Quiz and Symptom Checker, provide health information to our representatives or staff and from third party health service providers, health practices and hospitals, Stella’s contractors, suppliers and other associates, your guardian(s) or responsible person(s), your health fund, through Medicare;
- use your health information to consider your answers to our PTSD Quiz and Symptom Checker, facilitate the provision of health care services to you by third party health service providers, health practices and hospitals, to comply with our legal, financial, and reporting obligations, to enhance our services, and to conduct health and medical research, analysis and related purposes;
- disclose your health information to health service providers, health practices, hospitals, and Stella’s related entities, at medical conferences (provided that your health information is de-identified, to the extent that is reasonably practicable) and where the disclosure is required by law in the discharge of our statutory obligations; and
- Manage and improve our business and operational processes, products offered or to inform the strategic direction of Stella.
3. More Information
Stella’s Privacy Policy contains more information about how Stella handle your health information and other personal information about you, including information about:
- how we protect your health information and other personal information from unauthorised access and/or disclosure;
- the circumstances under which we may disclose your health information overseas;
- how you can access the personal information that we hold about you and have any inaccurate information corrected;
- how you can complain if you feel that your privacy has been breached, and how Stella will handle any such complaint.
A copy of Stella’s Privacy Policy can be found on the Privacy page of our website, accessible here: Privacy Policy, or by requesting a copy from Stella via management@stellacentre.com.au
