Common use of Confidential Medical Information Clause in Contracts

Confidential Medical Information. This information is intended to assist the school in the case of any medical emergency. All information is held in confidence. Under the Information Privacy Xxx 0000 and the Health Records Xxx 0000, schools have a duty to protect the privacy of the individual with regard to their personal and health information. All the personal and health information collected by this form will be kept confidential and only used for the purpose of providing appropriate care of your child. Health information is requested so that staff can properly care for the student and withholding health information that may be required can put the student’s health at risk. Name of emergency contact 1: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Name of emergency contact 2: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Private insurance cover fund and number: …….………………….………………………………………... ……….……………………………….………………………………………………………………........... Family Doctor name: …………………….………………………………………………….………....... Practice name and suburb: …………………………….…………………………………………….……… Contact phone number: ……………………………… Email address: …………………………….…… Please tick if your child suffers any of the following:

Confidential Medical Information. This information is intended to assist the school School in the case of any medical emergency. All information is held in confidence. Under the Information Privacy Xxx 0000 and the Health Records Xxx 0000, schools have a duty to protect the privacy of the individual with regard to their personal and health information. All the personal and health information collected by this form will be kept confidential and only used for the purpose of providing appropriate care of your child. Health information is requested so that staff can properly care for the student and withholding health information that may be required can put the student’s health at risk. Name of emergency contact 1: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Name of emergency contact 2: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Private insurance cover fund and number: …….………………….………………………………………... ……….……………………………….………………………………………………………………........... Family Doctor name: …………………….………………………………………………….………....... Practice name and suburb: …………………………….…………………………………………….……… Contact phone number: ……………………………… Email address: …………………………….…… Please tick if Does your child suffers suffer from any of the following:: (please tick)  Asthma  Bed wetting  Blackouts  Diabetes  Dizzy spells  Fits of any type  Heart condition  Migraine  Sleepwalking  Travel sickness  Other Please provide details : …………….…………………………………….…………..................................... ………….…………………………………….…………….…………………………………….…….........

Confidential Medical Information. This information is intended to assist the school in the case of any medical emergency. All information is held in confidence. Under the Information Privacy Xxx 0000 Act 2000 and the Health Records Xxx 0000Act 2001, schools have a duty to protect the privacy of the individual with regard to their personal and health information. All the personal and health information collected by this form will be kept confidential and only used for the purpose of providing appropriate care of your child. Health information is requested so that staff can properly care for the student and withholding health information that may be required can put the student’s health at risk. Name of emergency contact 1: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Name of emergency contact 2: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Private insurance cover fund and number: …….………………….………………………………………... ……….……………………………….………………………………………………………………........... Family Doctor name: …………………….………………………………………………….………....... Practice name and suburb: …………………………….…………………………………………….……… Contact phone number: ……………………………… Email address: …………………………….…… Please tick if your child suffers any of the following:

Confidential Medical Information. This information is intended to assist the school in the case of any medical emergency. All information is held in confidence. Under the Information Privacy Xxx 0000 and the Health Records Xxx 0000, schools have a duty to protect the privacy of the individual with regard to their personal and health information. All the personal and health information collected by this form will be kept confidential and only used for the purpose of providing appropriate care of your child. Health information is requested so that staff can properly care for the student and withholding health information that may be required can put the student’s health at risk. Name of emergency contact 1: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Name of emergency contact 2: ………….……………………………….………………………………… Best contact number(s): ………….……………………………….………………………………………… Private insurance cover fund and number: …….………………….………………………………………... ……….……………………………….………………………………………………………………........... Family Doctor name: …………………….………………………………………………….………....... Practice name and suburb: …………………………….…………………………………………….……… Contact phone number: ……………………………… Email address: …………………………….…… Please tick if your child suffers any of the following::  Asthma  Bed wetting  Blackouts  Diabetes  Dizzy spells  Fits of any type  Heart condition  Migraine  Sleepwalking  Travel sickness  Other Please provide details of your child’s allergies: …………….…………………………………….………… ………….…………………………………….…………….…………………………………….…….........