{"id":60,"date":"2025-07-18T12:50:08","date_gmt":"2025-07-18T12:50:08","guid":{"rendered":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/?page_id=60"},"modified":"2025-07-18T12:51:06","modified_gmt":"2025-07-18T12:51:06","slug":"privacy-agreement-form","status":"publish","type":"page","link":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/privacy-agreement-form\/","title":{"rendered":"Privacy Agreement Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"60\" class=\"elementor elementor-60\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d9fe3a9 e-flex e-con-boxed e-con e-parent\" data-id=\"d9fe3a9\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a4f42bd elementor-widget elementor-widget-shortcode\" data-id=\"a4f42bd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f62-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"62\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/60#wpcf7-f62-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"62\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f62-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"form_Sec\">\n\t<p class=\"w-100\">Disability Services 24\/7 values your privacy and is committed to protecting your personal data. This document outlines the reasons why we collect, use, and disclose your personal information, and seeks your consent for these actions.\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">Handling and Disclosure of Your Personal Information\n\t<\/p>\n\t<p class=\"w-100\">The personal data we handle may include details about you and any disabilities. This encompasses records made by us or other healthcare professionals, as well as images or videos capturing your conditions, taken by either us or other professionals.\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">Purpose of Using Your Personal Information\n\t<\/p>\n\t<p class=\"w-100\">We utilize your personal data to deliver, manage, and oversee your care and any related activities.\n\t<\/p>\n\t<p class=\"w-100\">Your personal information may be shared with:\n\t<\/p>\n\t<p class=\"w-100\">1. Funding bodies associated with Disability Services 24\/7\n\t<\/p>\n\t<p class=\"w-100\">2. Your physician and other NDIS service providers\n\t<\/p>\n\t<p class=\"w-100\">3. Government and regulatory entities, including the National Disability Insurance Agency, Medicare, state disability agencies, and the Australian Taxation Office\n\t<\/p>\n\t<p class=\"w-100\">4. NDIS accredited auditors for audit and quality assurance purposes, relevant to our NDIS provider registration. You are automatically included in these audits but can opt out anytime.\n\t<\/p>\n\t<p class=\"w-100\">5. Your representatives, including legal guardians, executors, trustees, and legal advisors\n\t<\/p>\n\t<p class=\"w-100\">6. Law enforcement, the Disability Services Commissioner, or in response to legal mandates\n\t<\/p>\n\t<p class=\"w-100\">7. Payment processing financial institutions\n\t<\/p>\n\t<p class=\"w-100\">8. Contracted service providers of Disability Services 24\/7\n\t<\/p>\n\t<p class=\"w-100\">9. Other parties when required by law without your consent\n\t<\/p>\n\t<p class=\"w-100\">10. Additional parties as mentioned in our Privacy and Dignity Policy\n\t<\/p>\n\t<p class=\"w-100\">In certain situations, your data might be shared without your consent if the law mandates it.\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">Privacy Complaints and Incidents\n\t<\/p>\n\t<p class=\"w-100\">Our Privacy and Dignity Policy details how you can access your data, lodge privacy complaints, and how such complaints are processed in line with our Feedback and Complaints Management Policy. We take privacy breaches seriously, managing them via our Incident Management System as described in our Incident Management and Reporting Policy. More information can be found within this policy.\n\t<\/p>\n\t<p class=\"w-100\">For inquiries, including requests for our policy documents, you can contact us at:\n\t<\/p>\n\t<p class=\"w-100\">Disability Services 24\/7\n\t<\/p>\n\t<p class=\"w-100\"><a href=\"maito:admin@disabilityservices247.com.au\">admin@disabilityservices247.com.au<\/a>\n\t<\/p>\n\t<p class=\"w-100\">Telephone <a href=\"tel:0430 431 318\">0430 431 318.<\/a>\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">Can I revoke or modify my consent regarding the use of my personal information?\n\t<\/p>\n\t<p class=\"w-100\">You have the right to withdraw or change your consent regarding the handling of your personal data by Disability Services 24\/7 at any time through a written notification.\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">PLEASE INDICATE YOUR CHOICE BELOW:\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">A. Consent by Client\n\t<\/p>\n\t<div class=\"formGroup\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"paf1\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"paf1[]\" value=\"By reading this Privacy Agreement Form and the Disability Services 24\/7 Privacy and Dignity Policy, I give my consent for my personal data to be used as described here and according to my specified preferences in the policy.\" \/><span class=\"wpcf7-list-item-label\">By reading this Privacy Agreement Form and the Disability Services 24\/7 Privacy and Dignity Policy, I give my consent for my personal data to be used as described here and according to my specified preferences in the policy.<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p class=\"w-100 fw-bold\">B. Consent by Guardian\/Parent on Behalf of Client\n\t<\/p>\n\t<div class=\"formGroup\">\n\t\t<p><label>Authorized Representative of<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"paf2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Acknowledgment of Privacy and Dignity Policy<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf3\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"paf3[]\" value=\"I confirm that I have reviewed the Privacy and Dignity Policy Statement and consent on the client&#039;s behalf to the use of their personal information as outlined. My personal data may also be used in managing this consent.\" \/><span class=\"wpcf7-list-item-label\">I confirm that I have reviewed the Privacy and Dignity Policy Statement and consent on the client&#039;s behalf to the use of their personal information as outlined. My personal data may also be used in managing this consent.<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p class=\"w-100 fw-bold\">MANAGING DISCLOSURE (COMPLETE AS NEEDED)\n\t<\/p>\n\t<div class=\"formGroup\">\n\t\t<p><label>1. I direct that my\/the Client\u2019s personal information not be disclosed to the following individuals or entities: (please specify)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf4\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"paf4\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>2. Besides those mentioned in the Privacy Agreement Form and Policy, I consent to sharing my\/the Client\u2019s personal information with the following: (please specify)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf5\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"paf5\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p class=\"w-100 fw-bold\">CONSENT WITHDRAWAL (IF APPLICABLE)\n\t<\/p>\n\t<div class=\"formGroup\">\n\t\t<p><label>3. Despite the above, I do not consent to Disability Services 24\/7 using my\/the Client\u2019s personal information for:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf6\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"conducting quality assurance activities including conducting surveys, research and analysis and resolving complaints.\" \/><span class=\"wpcf7-list-item-label\">conducting quality assurance activities including conducting surveys, research and analysis and resolving complaints.<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"NDIS audit and other quality assurance activities in respect of Disability Services 24\/7 related to Disability Services 24\/7 obtaining or maintaining registration as an NDIS registered provider\" \/><span class=\"wpcf7-list-item-label\">NDIS audit and other quality assurance activities in respect of Disability Services 24\/7 related to Disability Services 24\/7 obtaining or maintaining registration as an NDIS registered provider<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"promoting Disability Services 24\/7 and its activities, including through events and forums\" \/><span class=\"wpcf7-list-item-label\">promoting Disability Services 24\/7 and its activities, including through events and forums<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"recruiting employees, contractors and volunteers.\" \/><span class=\"wpcf7-list-item-label\">recruiting employees, contractors and volunteers.<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"evaluating Disability Services 24\/7\u2019s work and reporting externally\" \/><span class=\"wpcf7-list-item-label\">evaluating Disability Services 24\/7\u2019s work and reporting externally<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"carrying out internal functions including training\" \/><span class=\"wpcf7-list-item-label\">carrying out internal functions including training<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"receiving marketing communications from Disability Services 24\/7, that consent will remain current until they advise Disability Services 24\/7 otherwise. However, individuals can opt out at any time\" \/><span class=\"wpcf7-list-item-label\">receiving marketing communications from Disability Services 24\/7, that consent will remain current until they advise Disability Services 24\/7 otherwise. However, individuals can opt out at any time<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"receiving Disability Services 24\/7 newsletter (individuals can opt out at any time)\" \/><span class=\"wpcf7-list-item-label\">receiving Disability Services 24\/7 newsletter (individuals can opt out at any time)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"where the personal information comprises photos, publication on Disability Services 24\/7\u2019s website or social media profile\" \/><span class=\"wpcf7-list-item-label\">where the personal information comprises photos, publication on Disability Services 24\/7\u2019s website or social media profile<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"paf6[]\" value=\"such personal information being recorded in audio and\/or visual format\" \/><span class=\"wpcf7-list-item-label\">such personal information being recorded in audio and\/or visual format<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>I would like a copy of this signed Privacy Agreement Form and the Privacy and Dignity Policy. <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf7\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"paf7\" value=\"Please select\" \/><span class=\"wpcf7-list-item-label\">Please select<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"paf7\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"paf7\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>If Yes, Preferred Delivery Method (Email or Postal Address)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf8\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"paf8\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Declaration by Disability Services 24\/7 Staff Member<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"paf9\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"paf9[]\" value=\"I certify that I have discussed this form&#039;s content with the Client, including the handling of their personal and sensitive information.\" \/><span class=\"wpcf7-list-item-label\">I certify that I have discussed this form&#039;s content with the Client, including the handling of their personal and sensitive information.<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p class=\"w-100 fw-bold\">Need Clarification? Reach Out to Us!\n\t<\/p>\n\t<p class=\"w-100\">Our goal is clear communication. While we strive for simplicity and have multilingual staff, we can provide interpreters and advocates for further assistance. Synergy Lifecare is ready to secure bilingual staff or qualified interpreters to ensure you fully understand this document.\n\t<\/p>\n\t<div class=\"subBtn\">\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner prime-btn\" type=\"submit\" value=\"Submit\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-60","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/60","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/comments?post=60"}],"version-history":[{"count":4,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/60\/revisions"}],"predecessor-version":[{"id":65,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/60\/revisions\/65"}],"wp:attachment":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/media?parent=60"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}