New Patient Consent

New Patient

Name

First Name

Last Name

Date of Birth

Gender

Male

Female

Address

City

State

Post Code

Phone

Non-Consent for Personal Information Disclosure

I do not consent to my personal information being disclosed to the following:

This clinic is using Lyrebird Health

Lyrebird Health is a medical scribe tool to help health practitioners record accurate clinical notes during a patient consultation.

Lyrebird Health listens in the background, capturing only the relevant details relating to clinical documentation requirements. These details are then transcribed into text to be sent to your health practitioner’s Electronic Medical Record system.

Transcription is performed exclusively within Australia
Audio file is immediately destroyed post-transcription
Transcription is redacted of sensitive, personal identifying information received
The transcript is encrypted - it is not stored in its original form
Only your health practitioner can access this content
At the discretion of the practitioner, data may be stored temporarily in Lyrebird.

If you have any questions, please ask your health practitioner.

Learn more about how Lyrebird Health is ensuring your privacy at https://www.lyrebirdhealth.com/patient

Patient Acknowledgement

Your authority for the release and collection of medical information

I authorise and consent to any health professional, legal representative, rehabilitation provider, case manager and other providers, disclosing, releasing, or discussing records containing to my personal medical information, between one another. I understand that the medical information is required for the purposes of determining and managing my compensation claim, to assist with my treatment.

I authorise and consent to a a photocopy of this Authority being sufficient evidence of my authority and consent to discuss or provide the medical information requested.

I authorise my health practitioner to use Lyrebird Health to help transcribe clinical notes.

Signature

Clear

If you are human, leave this field blank.

This clinic is using Lyrebird Health

Patient Acknowledgement

Location

Specialist Occupational Medical Services