Consent Form

This consent form confirms that I, as a client of Broadleaf, Holistic Nurse Practitioner Services agree to the terms and conditions and privacy policy of the service as listed on the company website: https://broadleafhnpservices.com. This consent is applicable to any revisions made to the terms and conditions and privacy policy on the website made after the date of signing the consent form. If any changes are made to the Privacy Policy and or Terms of Conditions on the website, you will be notified by email.  

Terms of services:

This document outlines the terms and conditions of Broadleaf: Holistic Nurse Practitioner Services as well as your rights and responsibilities as the client and/or primary carer in relation to information security, access and confidentiality as well as obligations regarding fees, cancellations and rebates. In these terms and conditions ‘we’, ‘us’, ‘our’ or ‘Broadleaf’ refers to ‘Broadleaf: Holistic Nurse Practitioner Services’.

All information obtained during sessions are kept confidential and secure, except when:

(1) It is subpoenaed by a court;

(2) Failure to disclose the information would place you or another person at risk of harm; or

(3) Your prior approval has been obtained to:

(a) Provide a written report to another professional or agency – e.g., to a lawyer; or

(b) Discuss the material with another person – e.g., a parent or school counsellor.

If you claim rebates from funding bodies, doctors and health practitioners may be required to provide summary reports to referring doctors, specialists and/or agencies regarding your progress. Health research using de-identified data may be undertaken by Broadleaf: Holistic Nurse Practitioner Services, by funding bodies which you consent to as a client of this clinic.

Consent to contact your General Practitioner

This agreement signifies your consent for Broadleaf to collaborate with your General Practitioner. This collaboration will involve updates on your symptoms’ evolution, progress and your intention to engage in therapy and treatment. We will also ask you if you will provide verbal consent for Broadleaf to share your recovery plan with a support person of your choice/other people in your care team e.g a Psychologist or NDIS support worker. Broadleaf has found it is helpful to include these people in the loop with information regarding your recovery. However, Broadleaf will respect whatever decision you feel is best for you in this regard. Confidentiality is paramount in my practice, and outside these circumstances (aside from those involving direct risk to yourself and others), Broadleaf will not share additional information without securing further specific consent from you.

Personal information about you is collected to enable your treatment. All notes taken during your treatment and all
communications relating to your treatment become a part of your clinical records.

Your clinical records are stored electronically in your client file, which you consent to as a client of this clinic. For clients who are being seen privately, in your Patient Personal Health Record, you will have access to your reports, therapy worksheets and other information from your clinical file that your Nurse Practitioner wishes to share with you.

As a client of broadleaf, you have a general right to access your records (subject to some exceptions which mainly relate to privacy, health or legal considerations) and you can request access to your records. Your request must be made in writing to Broadleaf, after which your request will be discussed with you. For clients who are 18 years or over, we are required to store your personal information for seven years after ceasing engagement with your treating Broadleaf. If you were under 18 at the time of commencing services with Broadleaf, we are required to store your personal information until you are age 25.

You will be emailed the details of your initial/next appointment as agreed verbally between yourself and Broadleaf at the time of making the appointment. It remains your responsibility to be aware of your scheduled appointments.

Your session will last the scheduled amount of time you booked in, which is 50 minutes. If you are late, your consultation will usually still finish at the scheduled completion time, to be fair to your treating Nurse Practitioner and the clients with sessions after yours. You will also still be charged for the full consultation.

Broadleaf has a cancellation policy in place to ensure that adequate time is provided for another client to access the service if the initial client cannot attend their appointment. As an independent practitioner, Broadleaf needs to also ensure that their time is accounted for.

Broadleaf understands an emergency may arise and you may not be able to attend your session as planned.

You can reschedule or cancel your appointment no less than 48 hours before your appointment (business hours Monday to Thursday) through emailing Broadleaf: Holistic Nurse Practitioner Services at: broadleaf.hnp.services@gmail.com.

With less than 48 hours notice to cancel your appointment (business hours Monday-Thursday), the full fee of the appointment will be charged.

If you are late for your appointment, your Nurse Practitioner will continue to try to connect to you (via phone) for at least 10 minutes after your scheduled appointment time. After this, it will be considered a ‘No Show’ and the full gap fee of your appointment will be charged.

In case of serious illness or other extenuating circumstances, no-show fee may be reviewed at Broadleaf’s discretion.

Thank you for your understanding and respect of the cancellation and no-show policy.

Fees will be automatically debited at the time of your scheduled appointment. Payments accepted include credit/debit card. Your payment information will need to be gathered from you prior to making your first appointment and will be entered securely into Halaxy.

All medicare rebates will be processed at the time of your scheduled appointment. Your Medicare details will need to be gathered from you prior to making your first appointment and will entered securely into Halaxy.

Unless if specified by Broadleaf for particular services, you will not be issued with an invoice for your initial assessment, standard sessions or for bulk billing. However, deductions for session payments and medicare rebates will be available on your bank account. You can login to Medicare via your My Gov account for information on your medicare rebates. You can also sign up to join the Halaxy portal to view all of your invoices. If you would like to have access to a personal portal on Halaxy please let Broadleaf know. More information about the patient portal on Halaxy can be found here:
https://support.halaxy.com/hc/en-au/articles/1500000076901-Intro-to-Halaxy-for-Patients

By signing this agreement, you are agreeing to Halaxy’s Terms and Conditions. These can be on their website https://www.halaxy.com/article/terms-consumer

Please note that out of pocket expenses (gap fees) do not apply for clients under the NDIS, Victims of Crime or those under a specific Aged Care Package.

Broadleaf provides support and case management for clients as needed in between formal sessions. This can include but is not exclusive to email and telephone support, revision of care plans, writing prescriptions, communicating with your care team, reviewing therapy exercises and assessment results, case reviews, scheduling and rescheduling appointments. To enable Broadleaf’s time to be covered in this domain: signing this agreement provides written consent for Broadleaf to bulk bill you through Medicare for this support. Bulk billing means that a Medicare rebate is paid to Broadleaf. A record of these occasions of service will be kept on your Medicare record.

Bulk billing means that you pay no out of pocket cost for the care and support that has been provided for you at the time.

Broadleaf allows you to claim Medicare rebates instantaneously using online Medicare claiming. This means that you do not have to go to the trouble of taking your invoice to a Medicare office or online to claim any Medicare rebates. Instead, Broadleaf electronically submits the claim to Medicare within our client management system Halaxy, and Medicare automatically pays the rebate directly into your bank account within 24-28 hours (business days).

By providing your Medicare card details, you agree to receive Medicare rebates as entitled as well as agreeing to assign the Medicare benefit “assignment of benefit” to Broadleaf should they bulk-bill you for a service outside of an initial assessment or standard session where a gap fee applies.

For the purposes of ensuring that Broadleaf’s time is best used for the support of clients rather than added administration time for you and Broadleaf, you will not be informed on each occasion of when you are bulk billed for a service. The reason for the bulk billing is generally self-explanatory as it will involve some sort of direct contact with you (phone/email). However if you would like further information regarding what each occasion of bulk billing was related to, please email Broadleaf at the time of the occasion of service.

Broadleaf works with children. Broadleaf does their best to be open and communicative with a child’s parent/guardian, however cannot disclose personal or sensitive information if the child does not provide explicit permission (verbal or written) to do so. If there is any risk of harm to self or others, this will be disclosed to the parent in a timely manner.

If you are unable to have your session face-to-face for any reason (e.g you cannot attend the appointment face to face or Broadleaf is unable to do so), your session will be online (i.e., phone session or video conference). This alternative will allow you to keep continuity in your treatment.

Broadleaf’s Nurse Practitioner will aim to:

  • Provide the service as advertised
  • Be open and honest about how they can help
  • Be polite and respectful
  • Respect your values and beliefs
  • Assist you to make informed choices
  • Protect you from violence, abuse or discrimination
  • Provide joint decision making about the services and support offered
  • Listen to feedback and resolve any issues
  • Keep information confidential and secure
  • Minimise conflict between you and the organisation
  • Abide by all relevant legislation
  • Review how the service is working for you
  • Accept complaints and feedback
  • Implement any suitable changes as a result of feedback

 

As a company, Broadleaf will aim to:

  • Resolve all escalated concerns in a timely manner
  • Ensure you receive invoices/receipts
  • Ensure your Medicare rebate is paid (if applicable)
  • Abide by all relevant legislation
  • Accept complaints and feedback
  • Implement suitable changes as a result of feedback
 

Broadleaf reserves the right to discontinue care with the client at any point if they feel this is appropriate. Broadleaf wherever possible, will endeavour to provide the client with referral pathways as well as short- and long-term treatment plans and recommendations.

Should you have any questions or concerns about this or anything else, please do not hesitate to contact Broadleaf: Holistic Nurse Practitioner Services at: broadleaf.hnp.services@gmail.com

Privacy Policy

This Privacy Policy sets out our commitment to protecting the privacy of personal information provided to us, or otherwise collected by us, offline or online, including through Broadleaf’s website: broadleafhnpservices.com. In this Privacy Policy ‘we’, ‘us’, ‘our’ or ‘Broadleaf’ refers to ‘Broadleaf: Holistic Nurse Practitioner Services’.

The types of personal information we may collect about you include:

  • Your name;
  • Your contact details, including email address, and/or telephone number;
  • Your browser session and geo-location data, device and network information, statistics on page views and sessions, acquisition sources, search queries and/or browsing behaviour;
  • Information about your access and use of our site, including through the use of Internet cookies, your communications with our site, the type of browser you are using, the type of operating system you are using and the domain name of your Internet service provider;
  • Additional personal information that you provide to us, directly or indirectly, through your use of our site, associated applications, associated social media platforms and/or accounts from which you permit us to collect information; and
  • Any other personal information requested by us and/or provided by you.

We may collect these types of personal information directly from you or from third parties.

We may collect, hold, use and disclose personal information for the following purposes:

  • To enable you to access and use our site, associated applications and associated social media platforms;
  • To contact and communicate with you;
  • For internal record keeping and administrative purposes;
  • For analytics, market research and business development, including to operate and improve our site, associated applications and associated social media platforms;
  • To comply with our legal obligations and resolve any disputes that we may have.

We may disclose personal information to:

  • Third party service providers for the purpose of enabling them to provide their services, including (without limitation) IT service providers, data storage, web-hosting and server providers, maintenance or problem-solving providers, professional advisors and payment systems operators;
  • Our employees, contractors and/or related entities;
  • Our existing or potential agents or business partners;
  • Courts, tribunals and regulatory authorities, in the event you fail to pay for services we have provided to you;
  • Courts, tribunals, regulatory authorities and law enforcement officers, as required by law, in connection with any actual or prospective legal proceedings, or in order to establish, exercise or defend our legal rights;
  • Third parties to collect and process data, such as Google Analytics or other relevant businesses. This may include parties that store data outside of Australia.

 We may store personal information overseas. Where we disclose your personal information to the third parties listed above, these third parties may also store, transfer or access personal information outside of Australia.

We are committed to ensuring that the personal information we collect is secure. In order to prevent unauthorised access or disclosure, we have put in place suitable physical, electronic and managerial procedures to safeguard and secure the personal information and protect it from misuse, interference, loss and unauthorised access, modification and disclosure.

We cannot guarantee the security of any information that is transmitted to or by us over the Internet. The transmission and exchange of information is carried out at your own risk. Although we take measures to safeguard against unauthorised disclosures of information, we cannot assure you that the personal information we collect will not be disclosed in a manner that is inconsistent with this Privacy Policy.

Choice and consent: Please read this Privacy Policy carefully. By providing personal information to us, you understand we will collect, hold, use and disclose your personal information in accordance with this Privacy Policy. You do not have to provide personal information to us, however, if you do not, it may affect your use of this site or the products and/or services offered on or through it.

Information from third parties: If we receive personal information about you from a third party, we will protect it as set out in this Privacy Policy. If you are a third party providing personal information about somebody else, you represent and warrant that you have such person’s consent to provide the personal information to us.

Access: You may request details of the personal information that we hold about you.  An administrative fee may be payable for the provision of such information.  In certain circumstances, as set out in the Privacy Act 1988 (Cth), we may refuse to provide you with personal information that we hold about you.

Complaints: If you believe that we have breached the Australian Privacy Principles and wish to make a complaint, please contact us using the details below and provide us with full details of the alleged breach. We will promptly investigate your complaint and respond to you, in writing, setting out the outcome of our investigation and the steps we will take to deal with your complaint.

We may use cookies on our site from time to time. Cookies are text files placed in your computer’s browser to store your preferences. Cookies, by themselves, do not tell us your email address or other personally identifiable information. However, they do allow third parties, such as Google and Facebook, to cause our advertisements to appear on your social media and online media feeds as part of our retargeting campaigns. If and when you choose to provide our site with personal information, this information may be linked to the data stored in the cookie.

We may use web beacons on our site from time to time. Web beacons (also known as Clear GIFs) are small pieces of code placed on a web page to monitor the visitor’s behaviour and collect data about the visitor’s viewing of a web page. For example, web beacons can be used to count the users who visit a web page or to deliver a cookie to the browser of a visitor viewing that page.

Our site may contain links to other websites. We do not have any control over those websites and we are not responsible for the protection and privacy of any personal information which you provide whilst visiting those websites. Those websites are not governed by this Privacy Policy.

We may, at any time and at our discretion, vary this Privacy Policy by publishing the amended Privacy Policy on our site. We recommend you check our site regularly to ensure you are aware of our current Privacy Policy.

For any questions or notices, please contact us here.