Plan Management Consent

My Care Planner (‘we, ‘us’, ‘our’) is committed to preserving the privacy and security of our clients’ (‘you’, ‘your’) personal information and we are aware of our obligations under the Australian Privacy Principles contained in the Australian Privacy Act 1988.

The personal information we process about you will include information about your physical and mental health and condition. We use your personal information to provide, manage and administer supports for you. If we do not have this personal information, we may not be able to provide, manage or administer the supports you have requested. In addition to this, we may also share your personal information:

with other professionals to assist them in providing supports to you;
with people that you request or permit us to keep informed of our activities in connection with you;
with third party service providers so that they can provide services to you;
to comply with any domestic or foreign laws and regulations that apply to us; and
to respond to demands and requests by domestic and foreign regulators, governments and law prevention, detection, investigation and enforcement authorities, tax, social or labour authorities, customs authorities and other authorities or official bodies, courts, tribunals, arbitrators, ombudsmen, mediators and dispute resolution bodies and their representatives, and professional and self-regulatory bodies.

Part 1: NDIS Participant Details

Full Name of Participant: *

NDIS Number: *

Part 2: Authorised Representative Details

Please note: Only complete this section if the Participant is not the primary decision-maker.

Full Name of Representative:

Relationship to Participant:

Parent/GuardianPlan NomineeLegally Appointed Guardian

Description of Relationship:

Part 3: Service Providers

Please select one of the options below or provide details of Service Providers with whom My Care Planner can share information for the purposes of providing plan management services.

I consent to share information with all of my Service Providers.

I do not consent to share information with all of my Service Providers.

I consent to share information with the following Service Providers only:

Part 4: Support Coordinator or Recovery Coach

Please provide details of your Support Coordinator or Recovery Coach with whom My Care Planner can share information for the purposes of providing plan management services.

Business Name:

Contact Person:

Individual Contact Email:

Business Contact Email:(for circumstances in which your main contact is not available, or there is no main contact person).

Telephone:

I consent to my Support Coordinator/Recovery Coach having read only access to my NDIS budget. Please tick if you provide consent, or leave blank if you do not provide consent.

Part 5: Audit Process

I am aware that I am automatically enrolled in audit processes and that the audit team of My Care Planner may contact me for interviews and/or file reviews to ensure that My Care Planner complies with the NDIS Practice Standards. If I choose not to participate in this audit process, I am aware that My Care Planner will document and respect my decision.

Please tick if you do not wish to be part of the audit process.

Part 6: Other

Please provide details of any other individual (e.g., members of your support network) with whom My Care Planner can share information for the purposes of providing plan management services.

Part 7: Signature

Please note: The signatory must be either the NDIS Participant or an Authorised Representative who is recognised by the NDIA as the plan nominee.

Print Full Name: *

Date: *

Signature: *

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