Patient Consent and Acknowledgement Deed

Introduction:

1. At the Individual’s request, the Service Provider has agreed to provide the Service to the Individual.

2. The DVA will pay the Service Provider directly for the Service provided to the Individual.

3. As part of the Service, the Service Provider will direct the Doctor to review the Medical Records.

4. Where the Service Provider (or the Doctor) receives personal information as defined under the Privacy Act 1988 (Cth) (Act), it will at all times comply with, and direct the Doctor to comply with, the Act.

The Individual acknowledges:

5. Other than provided for under this Deed, the Individual has no relationship whatsoever or howsoever with the Service Provider or the Doctor.

6. Neither the Doctor nor the Service Provider is:

(a) treating the Individual;

(b) providing the Individual with any medical treatment; or

(c) providing any medical advice to the Individual including any advice or opinion relating to previous medical treatments and diagnosis or misdiagnosis of the Individual.

7. The Individual is responsible for consulting with appropriate doctors and specialists in relation to the health and wellbeing of the Individual including in connection with the treatment of Specific Condition.

8. The Service Provider and Doctor have been engaged to review the Medical Records to provide the Service and will not be required to, and will not, consider any other Material.

9. Subject to paragraph 9, the Individual will not seek, and will not be provided with, any advice or treatment from the Service Provider or Doctor other than the Service.

10. The Service Provider may provide general information about the process for making a compensation claim with the DVA. The Service Provider disclaims any liability in connection with that information, and does not provide any warranty about its completeness or accuracy.

11. The Service Provider and Doctor do not owe a duty of care to the Individual except where such duty of care cannot be excluded or limited by law or in equity.

Release and Indemnity:

12. The Individual releases the Service Provider and Doctor from, and indemnifies and agrees to keep the Service Provider and Doctor indemnified against, any and all Claims and Liabilities (including associated legal, administrative and accounting costs on the indemnity basis) that the Individual has or if not but for this Deed may have against the Doctor or Service Provider arising from or in connection with the Service including but not limited to:

(a) any damage to property, personal injury or death; and
(b) any Claim or Liability that incurred by the Individual as a result of a medical or health condition.

13. The release and indemnity in accordance with paragraph 11 will be a continuing indemnity and will not be affected by any intervening act, matter or thing.

14. In this Deed, the following terms have the meaning given to them below unless the context requires otherwise:

(a) Claim: any claim, action, cause of action, demand or proceeding however arising and whether present or future, known or unknown, actual or contingent;
(b) Doctor: those doctors that the Service Provider engages to carry out the Service on behalf of the Service Provider;
(c) Deed: this Patient Consent and Acknowledgement Deed;
(d) DVA: the Department of Veteran Affairs;
(e) Individual: the individual named in the Medical Records and which is the subject of the Service;
(f) Liabilities: any loss, damage, cost or expense of a property, personal or other nature arising and whether present or future, known or unknown, actual or contingent;
(g) Material: any material relating to the health, medical status and wellbeing of the Individual other than the Medical Records, including reports, medical information, studies, charts, tables, schedules and data stored by any means;
(h) Medical Records: the medical records of the Individual provided by the Individual (or by the DVA on the Individual’s behalf) to the Service Provider and Doctor;

(i) Service: solely the following:
(i) identify any information in the Medical Records; and
(ii) a consultation by a Doctor with the Patient,
in respect of the Specific Condition.
(j) Service Provider: AUSVETERANS PTY LTD
(k) Specific Condition: the specific injury, diagnosis or medical condition that the Patient requests the Service in respect of, and that is or may, be recognized by the DVA to be compensable.

Executed as a Deed Poll in favour of each of the Service Provider and the Doctor (which rights may be enforced individually or collectively).