Patient and nominated Carer Platform Consent Form and Collection Notice
This Form describes how Southern Neurology Pty Ltd (Southern Neurology, Neuraly, we, us, our) will handle the Personal Information (including sensitive health information) it collects from Patients and Carers in connection with the Platform (Platform) used by a group of independent practitioners to provide services. Please review this Form carefully.
If you book an appointment on the Platform and will provide responses to our questions on behalf of a Patient, you (Carer) acknowledge and warrant that you have the appropriate authority to bind that Patient, and where relevant, you have informed them of the matters in this Form.
Collection Notice
What Personal Information do we collect?
Southern Neurology will collect personal information including:
•	identity and contact information, such as your name, age or date of birth, gender, address, email address and telephone number; 
•	information about the Patient's treating healthcare practitioner and health insurance membership details; 
•	if you use an electronic device to access our websites or the Platform, your IP address and device location information; and
•	sensitive health information of Patients, including details of their health and diagnoses, information about their current and historical symptoms and medication history, medication side effects, and their patient identifier (as nominated by their treating healthcare practitioner or institution) (Health Information),
(together, Personal Information).
How do we collect this Personal Information?
Southern Neurology will collect this information either:
•	directly from you, through your consultations and completion of Questionnaires; or  
•	in the case of Patients, indirectly, where unreasonable or impracticable to obtain directly from you, such as:
•	where it is collected by a relevant healthcare practitioner or institution, and then uploaded to the Platform; 
•	from a Carer who provides the relevant information either via the Questionnaires or to your treating healthcare practitioner or institution, on your behalf; and
•	where the Platform generates additional information about you and your health or symptoms based on other information maintained on the Platform. This generated information will constitute Health Information.
If we do not collect this information, we will not be able to enable you, Carers or treating healthcare practitioners to provide patient services via the Platform.
Purposes for which we collect, use and disclose your Personal Information
We collect, hold, use and disclose your Personal Information for our business operations and activities, including:
•	to provide, operate and improve the Platform, including to send you Questionnaires and provide you, Carers and treating healthcare practitioners with information and symptom updates that may assist in monitoring, managing and improving the Patient's health;
•	to communicate with you, your treating healthcare practitioners, institutions and other licensed healthcare providers, including to send you service, support and administrative messages, reminders, and information requested by you; and
•	as required or permitted by law, to resolve any disputes that we may have with any of our users, and enforce our agreements with third parties.
Southern Neurology may also use and disclose your Personal Information on a de-identified and aggregated basis for the purposes of:
•	analytics, including identifying trends or predictions for particular conditions or symptoms; and 
•	including it in reports provided to third party business partners, such as pharmaceutical, medical device and insurance companies and third party contract research organisations, clinical trial sites and medical service providers, for the purposes set out in our privacy policy, including to enable them to send materials to healthcare practitioners and institutions about services and products (including clinical trials, medications or courses of treatment) which may be relevant to their treatment of you, other patients or patient groups or clinical research. If you wish to opt-out of your Personal Information being provided to third parties for this purpose, you may do so by contacting us using the details in our Privacy Policy. Any such opt-out will only operate on a forward looking basis, as described in our Privacy Policy.
To whom do we disclose your Personal Information?
As described in our Privacy Policy, we may disclose personal information for the purposes described in this Form to:
•	treating healthcare practitioners and institutions; 
•	your Carer or specific third parties you authorise to receive personal information which we hold about you;
•	our employees and contractors and third party suppliers and service providers, including:
•	entities which host or enable us to operate our Platform and websites; and
•	our current or potential professional advisers and agents; and
•	other third parties as required, authorised or permitted by law.
Disclosure of Personal Information outside Australia
We store your data in Australia. While our business partners, to whom we disclose your Personal Information are located in Australia, some of them may share reports (containing your de-identified and aggregated personal information) with their third party providers or operations overseas, including in the USA, Switzerland, France, Japan, China, Germany, England, Sweden, Denmark, Israel, Ireland, the Netherlands and Italy. 
Privacy Policy
Southern Neurology will handle your Personal Information in accordance with its Privacy Policy which explains how: (i) Southern Neurology collects, uses, discloses, protects and handles your Personal Information; (ii) to access and seek correction of your Personal Information; (iii) to lodge a complaint regarding the handling of your Personal Information; and (iv) Southern Neurology will handle any complaint. 
Patient Consent
By booking an appointment on the Platform accessing the Platform, you:
•	consent to your Personal Information (including Patients' sensitive and Health Information) being disclosed by the relevant treating healthcare practitioner or Carer to Southern Neurology, for purposes set out in this Form;
•	acknowledge that your Personal Information (including Patients' sensitive and Health Information) will be collected and handled by Southern Neurology for purposes set out in this Form; and 
•	Acknowledge that your Personal Information will be transferred to, stored by and used by Southern Neurology, relevant service providers and trusted business partners, located outside your state of residence for purposes set out in this Form. 
You also acknowledge and agree that:
•	you are responsible for ensuring Personal Information you provide to Southern Neurology (including via healthcare practitioners or institutions or a Carer) is accurate, complete and up-to-date. We will not review or confirm the accuracy or completeness of this data; 
•	Southern Neurology, to the fullest extent permitted under Australian law, will not be liable for inaccuracies contained in, or resulting from, any Personal Information it is provided, including inaccuracies contained within generated reports and materials provided to healthcare practitioners or third party partners; and
•	you will comply with all applicable law in your interactions with us and the Platform.
You may cease to use the Platform at any time. However, this will not require us to retract Personal Information which has already been used (including where de-identified) or disclosed to other practice management systems or third parties. We may retain your Personal Information after you cease to use the Platform in order to comply with our legal retention obligations or our internal record keeping policies.