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I have read the information above and understand the reasons why the information must be collected
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I understand that I am not obliged to provide any information requested of me, but failure to do so may compromise the quality of health care and treatment given to me or if I provide information but want to put limitations on access or disclosure, I will discuss these with the practice beforehand.
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I am aware of my rights to access information collected about me, except in circumstances where access may be legitimately withheld. I understand I will receive and explanation of why the information is being withheld in these circumstances.
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I understand that if my information is to be used for any other purposes other than those set out above, my further consent will be obtained.
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I consent to the handling of my information by the practice for the purposes set out on this form.
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I understand that depending on the age of my child, and given my child’s right to privacy, in the clinical judgment of the doctor treating my child I may be prevented from access to information regarding my child’s healthcare.
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I understand that if I request access to information held about me, I may be charged a fee to cover the administrative costs in providing access.