Consent for release and storage of health information

Purpose

Brightly Health Limited (Brightly, we, us, our) provides an assessment and support services. To do this effectively, we may need access to your health and care information from a range of providers.

This information helps us prepare your health assessment and care plan, coordinate with your other health and care providers, and to support your ongoing care.

Consent for release of health information

By signing this form, you authorise us to request and receive your health and care information from your General Practitioner (GP); TestSafe and other Health New Zealand databases; aged care or residential facilities you are, or have been, a resident of; hospitals and specialist providers; allied health providers, such as physiotherapists, occupational therapists, dietitians, or speech-language therapists; ACC and other relevant government agencies involved in your health, wellbeing, or social support; and any other health or care provider who holds information reasonably relevant to your health, wellbeing, or support needs.

Only information necessary to support your health assessment, care planning, and related services will be requested.

You authorise providers referred to above to release this information directly to us. You understand that some providers (such as GP practices) may charge a fee for this service, which we will pay directly.

You release any health provider supplying this information from liability for doing so under this consent.

You also authorise us and our health professional to discuss or share relevant information with your GP, specialist, or other care providers where necessary for the provision of our services to you.

Consent for collection, storage, and use

You consent to us:

collecting, recording, and storing your health information securely, both electronically and in paper form, for as long as required by law; and
using your information for the purposes stated in our Privacy Policy, and otherwise in accordance with our Privacy Policy.

Your rights

You may see and request correction of your health information at any time by contacting us at privacy@agebrightly.co.nz.

You may withdraw your consent (in whole or part) at any time, though this may affect our ability to provide services. Withdrawal of consent will not affect information already collected or shared lawfully before the withdrawal.

Acknowledgement and signature

By signing below, you confirm that you:

have read and understood this form and our Privacy Policy; and
consent to the collection, release, discussion, use, and storage of your health information as described in this form and our Privacy Policy.