PRIVACY STATEMENT

Inge Gnatt takes her obligations under the Victoria Health Records Act 2001 and the Commonwealth Privacy Act 1988 seriously, and takes all reasonable steps to comply and protect the privacy of personal information that her practice holds in relation to you. All steps are taken to safeguard your personal health information to ensure that confidentiality is maintained and the information is stored securely.

We require your consent to gather personal information about you. Please read this information carefully.

As part of providing a psychological service to you, Inge Gnatt will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the psychological assessment and treatment that is conducted.

Access

You may access the material recorded in your file upon request, subject to the exceptions in the National Privacy Principle 6.

Confidentiality

All personal information gathered by Inge Gnatt during the provision of the psychological service will remain confidential and secure except when:

It is subpoenaed by court, or
Failure to disclose the information would place you or another person at risk, and/or there is a legal requirement to make a mandatory report to the Department of Fairness, Families and Housing and/or Police, or
Your approval has been obtained to

a. Provide a written report to another professional or agency (e.g., lawyer, GP, school) or

b. Discuss the material with another person (e.g., parent/carer, employer, school, supervisor). This might occur through referral to another mental health professional/practitioner and/or through reports given to Inge Gnatt or returned to her following these referrals.

c. Discuss the material with other mental health professionals, or students training in psychology and/or counselling or a related discipline for the purpose of patient care and teaching/training. Please let Inge Gnatt know if you do not want your information used for these purposes (b and c above) and this will be noted in your file. It is Inge Gnatt’s practice to have clinical supervision for her client work.

Fees

Fee is $195. Payment is expected on the day of service via direct bank transfer or cash.

Cancellation Policy

If for some reason you need to cancel or reschedule your appointment, please give me at least 48 hours notice. If the session time is not filled, you will be charged half the consultation fee.

Eir practice is unable to offer crisis/after hours services.

The attached charter explains your rights as a client of a psychologist.

I have read the information above and understand the reasons why my information must be collected. I am also aware that this practice has a privacy policy on handling patient information.

I understand that I am not obliged to provide any information requested of me but that my failure to do so might compromise the quality of the health care and treatment given to me.

I am aware of my right to access the information collected about me, except in some circumstances where access might be legitimately withheld. I understand that I will be given an explanation in these circumstances.

I understand that if my information is to be used for any other purpose other than that set out above, my further consent will be obtained.

I consent to the handling of my information by this practice for the purpose set out above, subject to any limitations on access or disclosure that I notify this practice of.

Please note: If after reading this page you are at all unsure of what is written, please discuss it with Inge Gnatt at any time.

TELEHEALTH CONSENT FORM

In addition to our general Informed Consent information, which includes information about confidentiality and its limits, information storage, informed consent to treatment, and consent to exchange information, we ask that you read and sign this specific Telehealth Client Informed Consent Form.

By agreeing to this consent form, I agree that:

I understand that the benefits of telehealth/video conferencing therapy sessions can include:

Continued access to my psychologist.
Continued therapeutic support as part of my treatment plan.
Avoiding the need for me to travel to my psychologist.

I also understand that there are potential risks and downsides of telehealth/video conferencing therapy sessions and that these can include:

Telehealth/video conferencing may not feel the same as face-to-face sessions.
Technical problems could affect the video/sound quality or connection, which may disrupt the session in some ways.
Although my psychologist chooses video conferencing software, which has end-to-end encryption and high-security standards, there is still a small risk of hacking or others tapping into the video connection.

I understand that my psychologist is taking the necessary precautions to ensure confidentiality, including:

Ensuring the privacy of the telehealth session is upheld in the same way an in-person session would be, by choosing a private location and/or using headphones.
Not allowing any voice or video recording of the session.

I have been informed of and understand the payment and or Medicare processes for my telehealth session, and I consent to comply with these.

I understand that I can ask questions about the telehealth session anytime. I understand that attending a telehealth/video conferencing session is not compulsory, and I can withdraw consent at any time.

If I do not wish to continue or if technical difficulties interfere with the session to the point where we cannot continue, a phone consultation will be offered as an alternative.