NDIS | Disability Service Providers | Enhanced Lifestyles

SC - QF126B Customer Client Consent to Collect Information Agreement


The need to collect your information

Only Enhanced Lifestyles and Lifestyle Assistance and Accommodation Service employees involved with your service, or are providing support to those caring for you, may see your personal or sensitive information. All Enhanced Lifestyles and Lifestyle Assistance and Accommodation Service are required to adhere to, and sign, code of conduct and confidentiality agreement upon employment.

The situation may arise where Enhanced Lifestyles and Lifestyle Assistance and Accommodation Service must collect information from other agencies in order to provide services to you. When considering who we collect information about you from our employees using the following principles as set out in Data Protection Act 1998:

  • Only collect information from those needed in order to provide good quality service.
  • Collect the minimum information necessary to ensure good quality service.

Customer/Client to complete

Part 1 – I agree to my information being shared with the following organisations:

Part 2 – I do NOT agree to information being shared with:

Customer Name:

Signature



The Client / Customer

Date:

NDIA Number:

Review of Consent
Consent should be reviewed on a regular basis as agreed with the Customer/Client. If there are any changes to this document a new form should be completed to reflect the current wishes of the Customer/Client (or, if the Customer/Client is incapable of giving consent, the review may be made by Enhanced Lifestyles and Lifestyle Assistance and Accommodation Service and/or the Customer/Client Representative should they feel it is necessary and in the best interest of the Customer/Client to do so).

Witness Name:

Witness Email:

Leave this empty:

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Signature Certificate
Document name: SC - QF126B Customer Client Consent to Collect Information Agreement
lock iconUnique Document ID: 4d9680999d73148440c31f213cfcb314806d300e
Timestamp Audit
December 16, 2020 1:19 pm ACDTSC - QF126B Customer Client Consent to Collect Information Agreement Uploaded by Enhanced Lifestyles - enhanced.website@gmail.com IP 150.107.191.212
December 16, 2020 1:31 pm ACDTSupport Coordinator - scforms@enhancedlifestyles.com.au added by Enhanced Lifestyles - enhanced.website@gmail.com as a CC'd Recipient Ip: 120.20.225.6