General Consent to Exchange Information & Authority to Act on Client’s Behalf
By completing this form, a client of RSL DefenceCare will enable RSL DefenceCare to liaise with nominated organisations and to act on their behalf in relation to a claim or potential claim to the extent of the authority given in this form. If you choose not to complete this form, RSL DefenceCare can provide you with advice, but cannot act on your behalf. This form is to be completed by persons (clients) seeking services from The Trustee for RSL Welfare and Benevolent Institution ABN: 61 603 206 488, (RSL DefenceCare).
For information or assistance with this form, please contact RSL DefenceCare on (02) 8088 0388.
Client Consent to exchange personal information
RSL DefenceCare may be required to exchange information with the following agencies; however this does not give RSL DefenceCare authority to act on your behalf with these agencies. By signing this form, you give RSL DefenceCare the authority to exchange information with the agencies listed below:
- Department of Veterans Affairs
- Veterans Review Board
- Department of Defence
- Australian Taxation Office
- Child Support Agency
- Medicare Australia
- ComSuper or other Superannuation Provider
- Any Commonwealth, State or Territory workers’ compensation authority
- Doctors, Hospitals and other health care professionals who have provided you with treatment
- Your current and or previous employer(s)
Authority to Act on a Client’s behalf
To provide you with services, RSL DefenceCare needs to be able to act on your behalf with a number of agencies. We ask you to nominate these agencies on Page 2 of this form. By doing so and signing this form, you authorise RSL DefenceCare to act on your behalf when dealing with the nominated third parties/agencies you have listed on all matters including but not limited to:
- enquiring on your behalf,
- acting and making changes on your behalf,
- receiving copies of correspondence, and
- attending appointments with you or on your behalf.
Authorising RSL DefenceCare to act on your behalf does not take away your right to contact the nominated third party/agency.
General Information about Privacy
To provide you with a professional level of service, RSL DefenceCare needs to collect personal information about you. At all times you have a right to have that personal information kept private and request a copy of all personal information recorded by RSL DefenceCare. RSL DefenceCare is bound by privacy and confidentiality laws that limit who can look at information about you and when it can be given out.
Your right to Privacy
Under the Privacy and Personal Information Protection Act 1998 and the Health Records and Information Privacy Act 2002, your personal information must be stored securely. On request, you must be told why the information is being collected, how it will be used and whether it will be given to or exchanged with another party so that service/s can be provided to you. If you believe that your privacy has been infringed you can make a complaint to RSL DefenceCare or the Privacy Commissioner at any time.
Client; any person, persons or agencies recorded on this form in the section headed “The Client”.
- RSL DefenceCare; any person or entity acting under the employment, subcontract or other authority of The Trustee for RSL Welfare and Benevolent Institution, ABN: 61 603 206 488.
- Nominated third party/agency; any person or agency recorded on this form in the section headed “Nominated Third Parties/Agencies”.
- Exchange; means to request, collect, record, distribute or otherwise engage in the use of.
- Service/s; has the meaning as defined in the letter of engagement and/or the client service charter available on request from RSL DefenceCare.
NOTE: Your consent is not needed for the use, disclosure or exchange of personal information if required or authorised by law in some instances including but not limited to child protection, urgent health and lawful investigation situations.