Location,38 Queen Street, Ulverstone, Tasmania 7315
1300 226 029

Authority to Release Information Form

Purpose of this form

You are interested in using the Health Angel Medication Reminder Service.

We need to contact your NDIS Service Providers to ask them for information about you so we can decide if the Health Angel Medication Reminder Service is suitable for you and can be funded under your NDIS Plan.

We may also need to ask your healthcare providers (for example your pharmacist or your general practitioner) about your medications for the same reason.

You give Your NDIS Service Providers and your healthcare providers authority to disclose any of your medical information that a pharmacist employed by SVIDA Pty Ltd asks them for.

You can withdraw your authority at any time.

We will not offer to provide you with any services until we decide the Health Angel Medication Reminder Service is suitable for you.

NDIS Service Provider means your:

  • Support Coordinator/Plan Manager
  • Local Area Coordinators
  • Service Providers
  • NDIA Coordinators
  • NDIS Planners, including:

You need to read this

Privacy and your personal information

The privacy and security of your personal information is important to us, and is protected by law. We need to collect this information so we can process and manage your applications and payments, and provide services to you. We only share your information with other parties where you have agreed, or where the law allows or requires it.

(the “Participant”)

Consent to SVIDA Pty Ltd contacting the listed NDIS Service Providers and healthcare providers to share and ask for information about me, and give authority to my NDIS Service Providers to release any information about me that SVIDA Pty Ltd requires

By the Participant or for and on behalf of the Participant
Taking the right medications at the right time is essential for your health