Assessment booklet

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ConsentForm.docx
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CHCCSM005 Develop, facilitate and review all aspects of case management

CHCCCS004 Assess co-existing needs

CHCCSM004 Coordinate complex case requirements

Consent Form

I, (insert client name) ________________________________________ hereby acknowledge that Operation Hope has advised me of the following:

· Operation Hope Privacy and Confidentiality Policy

· my right to access personal information

· my right to withdraw my consent at any time.

I am aware of, and understand that, the organisation may need to collect and disclose personal information to third parties (as required) in order to provide an improved level of care.

I nominate that my personal information disclosed only to the person or agencies listed below (insert name of third parties as agreed with client):

I understand that Operation Hope must comply with relevant privacy laws and I will contact the organisation immediately if I feel that these laws have been breached.

Name of Client

Signature

Date

Name of Case Manager

Signature

Date

Non-Consent Form

I do not give my consent for Operation Hope to collect and disclose my personal information to any third parties.

Name of Client

Signature

Date

Name of Case Manager

Signature

Date

Version: 1.0

Page 2 of 2

Created: April 2021

Last Reviewed: April 2021

Central Australian Institute of Technology Pty Ltd | CRICOS: 03217C |TOID: 22302

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