Hobsonville Family Doctors




About ScreEnrol

ScreEnrol is a new system at Hobsonville Family Doctors. ScreEnrol helps eligible people in our community, who wish to receive care at Hobsonville Family Doctors, to receive their government-funded cheaper doctor visits, by completing a simple 3 step registration form.


Please note that ScreEnrol requires a mobile or touch screen device to capture signature to submit enrolment


Fields marked with a * are mandatory fields that must be completed






He pūnaha hou a ScreEnrol i Hobsonville Family Doctors. Ka āwhina a Screenrol i te hunga e āhei ana i roto i tō tātau hapori, e hiahia ana ki te whiwhi manaakitanga i Hobsonville Family Doctors, kia whiwhi ai rātau i ngā toronga rata iti ake te utu mai i ngā tautoko pūtea a te kāwanatanga, mā te whakaoti i tētahi puka rēhita upane 3 māmā noa.


Kia mōhio, me whakamahi kē i tētahi pūrere pūkoro, matapā rānei mō ScreEnrol hei tuku i te whakaurunga.

Ko ngā āpure kua mākahia ki te * me mātua whakaoti ērā.






ScreEnrol 是 Hobsonville Family Doctors 採用的新系統。 只要輕鬆填寫完 ScreEnrol 三步驟申請單,我們社區中符合資格的民眾即可在 Hobsonville Family Doctors 取得醫療服務,並獲得由政府補助的優惠看診方案。


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請注意,您須透過行動或觸控式裝置來擷取簽名內容,以便提交 ScreEnrol 申請單。

標有 * 記號的是必須填妥欄目,不接受留空。






ScreEnrol은 Hobsonville Family Doctors 의 새로운 시스템입니다. ScreEnrol은 Hobsonville Family Doctors 에서 의료 서비스를 받고자 하는, 자격을 갖춘 지역사회 구성원들이 간단한 3단계의 등록 양식을 작성하고 정부의 재정 지원으로 더욱 저렴하게 의사의 진료를 받을 수 있게 도와드립니다.


Screenrol은 등록 양식 제출에 필요한 서명을 캡처하기 위해 모바일 기기 또는 터치스크린 기기의 사용이 요구됩니다.


*표시가 있는 부분은 필수 기입 항목입니다.
















Which ethnic group(s) do you belong to? Select one or more which apply to you




Date of Birth *

Rā Whānau















Residential Address (street, suburb, city) *

Wāhi noho kāinga (tiriti, tapa tāone, tāonenui)







Emergency Contact Details

Ngā Taipitopito Whakapā Ohotata
















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Dependant children under 16 years old


You can choose to enrol your dependant children under 16 years old with Hobsonville Family Doctors as long as you are their parent or legal guardian. You may be asked for documentation to confirm that you have the authority for any children you enrol. This evidence could be a birth certificate, adoption papers, guardianship papers or NZ Family Court confirmation.






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Dependant details 1












Dependant details 1


















Dependant details 2















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Dependant details 2

















Dependant details 3















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Dependant details 3




















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Dependant details 4














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Please select your current New Zealand Eligibility statement

Me tīpako tō tauākī Māraurau ki Aotearoa onāianei




Eligibility proof

Taunakitanga āheitanga

You are required to present evidence of eligibility in order to receive government subsidised doctor visits. Please complete the statement below

I confirm that, if requested, I can provide proof of my eligibility and:

E herea ana koe ki te whakaatu taunakitanga o tō āheitanga ki te whiwhi i ngā toronga rata e utua ana e te kāwanatanga; kei te hiahia koe ki te; Me whakaoti te tauākī i raro. E whakaū ana ahau, mēnā ka tonoa,

ka taea e au taku āheitanga te whakaatu, ā:


Eligibility proof

Taunakitanga āheitanga


You are required to present evidence of eligibility in order to receive government subsidised doctor visits. Please complete the statement below

I confirm that, if requested, I can provide proof of my eligibility and

E herea ana koe ki te whakaatu taunakitanga o tō āheitanga ki te whiwhi i ngā toronga rata e utua ana e te kāwanatanga; kei te hiahia koe ki te; Me whakaoti te tauākī i raro. E whakaū ana ahau, mēnā ka tonoa,

ka taea e au taku āheitanga te whakaatu, ā:



Using your mobile phone, please provide a photo of your proof of eligibility with your form. If you are a permanent resident this is your correspondence from NZ immigration. Otherwise this is your passport.

Te whakamahi i tō waea pūkoro, me tuku mai he whakaahua o tō āheitanga me tō puka. Mēnā he kainoho tūturu koe koinei tō tuhinga mai i NZ Immigration. Ki te kore, koinei tō urupare.



Photo specifications ▼

Ngā tohutohu whakaahua




Transfer of Medical Records

Whakawhitinga o Ngā Pūkete Hauora


In order to get the best care possible, I agree to the practice obtaining my records from my previous doctor. I also understand that I will be removed from their practice register.

Kia taea ai ngā manaakitanga pai rawa, e whakaae ana ahau ki te tiki atu a te whare rata i aku pūkete mai i taku rata o mua. E mōhio ana ahau ka tangohia mai ahau mai i tā rātau rēhita whare rata.



Current doctor and/or Practice name, and address (if known)

Rata, whare rata hoki/rānei onāianei me te wāhi noho (mēnā e mōhiotia ana)








My agreement to the enrolment process:


  • I intend to use Hobsonville Family Doctors as my regular and ongoing provider of general practice / GP / health care services.

  • I understand that by enrolling with Hobsonville Family Doctors I will be included in the enrolled population of Hobsonville Family Doctors’s Primary Health Organisation (PHO), and my name address and other identification details will be included on the Practice, PHO and National Enrolment Service Registers.

  • I have been given information about the benefits and implications of enrolment and the services Hobsonville Family Doctors and PHO provides along with the PHO’s name and contact details.https://www.comprehensivecare.co.nz/why-enrol/

  • I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.

  • I have read and I understand the Use of Health Information Statement. The information I have provided on the Enrolment Form will be used to determine eligibility to receive publicly-funded services. Information may be compared with other government agencies, but only when permitted under the Privacy Act.

  • I understand that the Practice participates in a national survey about people’s health care experience and how their overall care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the survey by informing the Practice. The survey provides important information that is used to improve health services.

  • I agree to inform Hobsonville Family Doctors of any changes in my contact details and entitlement and/or eligibility to be enrolled.



Signed:

The Use of Health Information Statement.

Use and confidentiality of your health information (fact sheet)

Your privacy and confidentiality will be fully respected. This fact sheet sets out why we collect your information and how that information will be used.

Purpose

We collect your health information to provide a record of care. This helps you receive quality treatment and care when you need it.

We also collect your health information to help:

  • keep you and others safe
  • plan and fund health services
  • carry out authorised research
  • train healthcare professionals
  • prepare and publish statistics
  • improve government services.

Confidentiality and information sharing

Your privacy and the confidentiality of your information is really important to us.

  • Your health practitioner will record relevant information from your consultation in your notes.
  • Your health information will be shared with others involved in your healthcare, and with other agencies with your consent, or if authorised by law.
  • You don’t have to share your health information, however, withholding it may affect the quality of care you receive. Talk to your health practitioner if you have any concerns.
  • You have the right to know where your information is kept, who has access rights, and, if the system has audit log capability, who has viewed or updated your information.
  • Your information will be kept securely to prevent unauthorised access.

Information quality

We’re required to keep your information accurate, up-to-date and relevant for your treatment and care.

Right to access and correct

You have the right to access and correct your health information.

  • You have the right to see and request a copy of your health information. You don’t have to explain why you’re requesting that information, but may be required to provide proof of your identity. If you request a second copy of that information within 12 months, you may have to pay an administration fee.
  • You can ask for health information about you to be corrected. Practice staff should provide you with reasonable assistance. If your healthcare provider chooses not to change that information, you can have this noted on your file.

Many practices now offer a patient portal, which allows you to view some of your practice health records online. Ask your practice if they’re offering a portal so you can register.

Use of your health information

Below are some examples of how your health information is used.

  • If your practice is contracted to a Primary Health Organisation (PHO), the PHO may use your information for clinical and administrative purposes including obtaining subsidised funding for you.
  • Your District Health Board (DHB) uses your information to provide treatment and care, and to improve the quality of its services.
  • A clinical audit may be conducted by a qualified health practitioner to review the quality of services provided to you. They may also view health records if the audit involves checking on health matters.
  • When you choose to register in a health programme (eg immunisation or breast screening), relevant information may be shared with other health agencies involved in providing that health programme.
  • The Ministry of Health uses your demographic information to assign a unique number to you on the National Health Index (NHI). This NHI number will help identify you when you use health services.
  • The Ministry of Health uses health information to measure how well health services are delivered and to plan and fund future health services. Auditors may occasionally conduct financial audits of your health practitioner. The auditors may review your records and may contact you to check that you received those services. 
  • Notification of births and deaths to the Births, Deaths and Marriages register may be performed electronically to streamline a person’s interactions with government.

Research

Your health information may be used in research approved by an ethics committee or when it has had identifying details removed.

  • Research which may directly or indirectly identify you can only be published if the researcher has previously obtained your consent and the study has received ethics approval.
  • Under the law, you are not required to give consent to the use of your health information if it’s for unpublished research or statistical purposes, or if it’s published in a way that doesn’t identify you.

Complaints

It’s OK to complain if you’re not happy with the way your health information is collected or used.

Talk to your healthcare provider in the first instance.  If you are still unhappy with the response you can call the Office of the Privacy Commissioner toll-free on 0800 803 909, as they can investigate this further.

 

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