RELEASE OF MEDICAL INFORMATION

To obtain a copy of medical records please download a copy of the form linked below, complete and return it to us at: PO BOX 33291, Melbourne VIC 3004

Link to form:

https://docs.google.com/document/d/1e5znjR-PDkFGlCgAaaBPvt-bCSjKgq3M/edit?usp=sharing&ouid=113092247004123473699&rtpof=true&sd=true

PLEASE NOTE:

• A $50 fee to cover the costs of scanning, printing and secure mail-out of medical records is required prior to distribution of medical information. Please make payment to:

              Account Name: Kerryn Saunders

              BSB: 063 120

              Account Number: 10196732

• Once payment and the relevant documentation is received, the medical information requested can be scanned and sent to the nominated address
• If the individual who the medical information belongs to is 18 years or older their permission and signature must be provided
• If the individual who the medical information belongs to is unable to provide Informed Consent, a copy of Power of Medical Attorney information must be provided along with the completed form
• Once the individual is 25 years of age their medical information will be securely destroyed