Privacy Consent Form

As an NDIS participant in our service, Pivotal Connect, we need your consent to collect, store, and use your personal information to effectively deliver services. Please review this form carefully along with the Service Agreement, and sign it if you agree to the stated terms.
1. Protection of Your Sensitive Information

We respect your privacy and dignity. Thus, we only collect sensitive information like health, medical, and disability-related information when it's needed for service provision and only if:

  • a. You provide explicit consent, or
  • b. We're legally required to do so.
2. Your Consent

Before you give consent, our Workers will explain how we will use your data and who it may be disclosed to. They will ensure you understand everything clearly, providing assistance such as interpreter services or legal aid, as necessary. This consent can be amended at any time.

3. Informing You about Your Information

We will regularly inform you about how your information is used and stored. You have a right to access, correct your data, or lodge a complaint. Should you prefer, we encourage your involvement with family, friends, or chosen community in this process.

4. Information Collected

We may collect the following personal information: Participant details, Identifiers, Service details, medical information, Financial information, and Interaction records. We may collect recorded material such as audio/visual formats.

5. How We Collect Information

We may gather your information from our website, your correspondence with us, forms filled by you, face-to-face interactions, events, third-party referrals, or government agencies.

6. Purpose of Information Collection

We use this information to customise your support plans, answer inquiries, manage and improve our services, adhere to legal obligations, inform you about our activities, perform research, and improve your website experience.

7. Third-Party Disclosures

We may disclose your data to NDIS Commission, funding providers, external auditors, regulatory bodies, law enforcement, courts, financial institutions, or external service providers, as necessary for service provision, legal compliance, or based on your authorization.

8. Access to Your Personal Information and Complaints

The Pivotal Connect Privacy and Information Management Policy includes information about how you can access your personal information we hold, and how to make a complaint about a breach of your privacy or the Privacy Act, which will be dealt in accordance with our Feedback and Complaints Policy.

9. Access to Your Personal Information and Complaint

Pivotal Connect does not contact participants through personal social media accounts. We will never share your name, image story, or any identifying information on social media or public platforms without separate, explicit written information.

10. Emergencies, Disasters + Critical Incidents

In the event of an emergency, disaster or critical incident during scheduled supports: Pivotal Connect may:

  • • Contact your emergency contact or authorised representative
  • • Share relevant information with emergency services
  • • Use your information to ensure your safety and wellbeing
  • • Record the incident in accordance with legal and reporting requirements

This is strictly for Duty of Care and Safety.

11. Handling of Privacy Breaches

Any breach or alleged breach of your privacy will be taken seriously. Such incidents will be reported and managed as per our Incident Management Policy.

12. Contacting Us

For questions, concerns, or to request a copy of our Privacy and Information Management Policy, Feedback and Complaints Policy, or Incident Management Policy, please contact us at 07 3063 3261 or info@pivotalconnect.com.au

13. Withdrawal of Consent

If you would like to adjust your consent regarding specific uses of your personal information by Pivotal Connect, kindly indicate your preferences by checking the corresponding boxes below:

Withdrawal of Consent
14. Sharing my information

I consentfor you to disclose my / the participant’s information to: (please specify name and contact details)

15. Future Withdrawal or Amendment of Consent

Please remember that your consent continues until you provide us with instructions to the contrary. You can withdraw or amend your consent to Pivotal Connect using your personal information at any time by providing written notice to Pivotal Connect.

16. Confirmation of Consent

By signing below, I confirm that I understand and agree to the use of my personal information as outlined above by Pivotal Connect.

MM slash DD slash YYYY
17. Consent by Representative (if applicable)

If you are providing consent on behalf of the participant, please complete the section below:

I have read Pivotal Connect’s Privacy and Information Management Policy and Incident Management Policy. I provide consent on behalf of the aforementioned Participant for the use of his/her personal information for the purposes set out and in accordance with the preferences set out above.

I also consent to my personal information being used to administer this consent and to provide evidence of this consent to third parties as necessary.

MM slash DD slash YYYY

18. Declaration by Pivotal Connect Worker

I, as a worker of Pivotal Connect, solemnly affirm that I have provided a comprehensive explanation of the details outlined in this form to the Participant. This includes a thorough description of how their personal and sensitive information will be managed and protected by Pivotal Connect.

MM slash DD slash YYYY
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