Consent to Share my Medical Record to DHR Link

Information

The ACT Digital Health Record (DHR) holds information about the care you have received from:

ACT Health
Canberra Health Services
North Canberra Hospital (formerly Calvary Public Hospital Bruce), and
Clare Holland House.

The DHR system can provide your general practitioner (GP) and their practice with access to your health careinformation through a web-based portal called DHR Link. Access to this information can help your GP make informed decisions about your treatment.

Your GP will already have access to information related to services they have referred you to. This includes:

any test results performed at Canberra Health Services or North Canberra Hospital (formerly Calvary
Public Hospital Bruce),
letters from the services they refer you to.

However, for your GP to access your full patient record, you need to agree (consent). If you provide thisconsent, and you see another GP in the same practice, they will also be able to access your health care record. Other members of the health care team working in that practice, including nurses and allied health staff, may also access your record to help co-ordinate your care delivery.

You can change your mind about your consent at any time

If you have a MyDHR account, you can update your preferences about sharing information to DHR Link. This is available through the mobile app or on the website.
If you do not have a MyDHR account, you can update your information with staff any time you receivetreatment at Canberra Health Services or North Canberra Hospital.
You can also call Health Information Services during business hours at:
- Canberra Health Services: 02 5124 2124
- North Canberra Hospital: 02 6201 6280

Consent to share my Medical Record to Digital Health Record (DHR) Link

((NOTE: you can log into MyDHR to complete this consent electronically and access will be given instantly)

Declaration of patient or authorised person

I consent to the ACT public health system giving my nominated GP and their GP practice access to my personal digital health record (past and future) through DHR Link.

I understand that the information my GP and their practice can access through DHR Link will include all results, orders, notes, images, alerts, and documentation associated with any care I have received within the ACT public health system.
I understand that information could contain sensitive information relating to notifiable diseases, mental health, and sexual health, if I have used public health services for these.
I understand that I have the right to withdraw my consent at any time.
I understand that if my GP/GP practice has already seen information provided through DHR Link before I withdraw my consent, they may document this information for their own records. Withdrawing my consent will not change this.
I understand that this consent applies to my current GP/GP practice and any GP/GP practice I attend in future.

Patient details

First Name *

Last Name *

Date of birth *

Contact phone number

Signature of Patient or authorised person (parent/carer/guardian): *

Clear

Please sign the form.

Date *Enter today’s date

Name of authorised person (if applicable):if applicable

Witness Name *

Witness signature *

Clear

If applicable

Current nominated GP name *

Current GP Practice Name: Next Practice Deakin

Next Practice Deakin will forward the completed form to Health Information Services at either of the following locations:

Canberra Health Services: CHS.HIS@act.gov.au
North Canberra Hospital: healthinformationservices@calvary-act.com.au