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Patient Agreement Form for New Zealand

Patient Agreement Form Template for New Zealand

A comprehensive legal agreement governed by New Zealand law that establishes the relationship between a healthcare provider and patient. The document outlines the terms of medical service provision, patient rights and responsibilities, privacy obligations under the Privacy Act 2020, consent requirements, and financial arrangements. It incorporates requirements from the Health and Disability Commissioner Act 1994 and the Code of Health and Disability Services Consumers' Rights, ensuring compliance with New Zealand's healthcare regulatory framework while providing clear guidelines for both healthcare providers and patients.

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What is a Patient Agreement Form?

The Patient Agreement Form serves as the foundational document establishing the legal and professional relationship between healthcare providers and patients in New Zealand. This document is essential for medical practices, clinics, and healthcare facilities to ensure compliance with New Zealand's healthcare legislation, including the Health and Disability Commissioner Act 1994, Privacy Act 2020, and Health Information Privacy Code. The agreement covers crucial aspects such as informed consent, privacy protection, service terms, and payment arrangements. It should be implemented at the commencement of any new patient relationship and updated as required by regulatory changes or service modifications. The document protects both healthcare providers and patients by clearly defining rights, responsibilities, and expectations within the therapeutic relationship.

What sections should be included in a Patient Agreement Form?

1. Parties: Identifies the healthcare provider and patient (including registration details of the provider and full legal name/contact details of the patient)

2. Background: Brief context about the healthcare provider's services and the purpose of the agreement

3. Definitions: Key terms used throughout the agreement including medical terminology, services, and legal terms

4. Services: Detailed description of medical services covered under the agreement

5. Patient Rights and Responsibilities: Outlines rights under the Code of Health and Disability Services Consumers' Rights and patient responsibilities

6. Consent and Authorization: Provisions for informed consent, including right to refuse treatment and withdrawal of consent

7. Privacy and Confidentiality: How patient information will be collected, stored, used and shared in accordance with Privacy Act 2020

8. Fees and Payment: Cost of services, payment terms, and billing procedures

9. Termination: Conditions under which either party may end the agreement

10. General Provisions: Standard legal clauses including governing law, amendments, and entire agreement

What sections are optional to include in a Patient Agreement Form?

1. Insurance and ACC Coverage: Include when services may be covered by insurance or ACC claims

2. Telehealth Services: Include when remote healthcare services are offered

3. Emergency Procedures: Include for practices offering emergency or after-hours care

4. Multiple Provider Authorization: Include when patient may be treated by multiple providers within the practice

5. Research Participation: Include if the practice conducts clinical research and may invite patient participation

6. Student Training: Include if the practice is involved in medical student training

7. Specific Treatment Protocols: Include for specialized medical services or specific treatment programs

What schedules should be included in a Patient Agreement Form?

1. Schedule 1: Fee Schedule: Detailed breakdown of fees for different services and procedures

2. Schedule 2: Privacy Policy: Detailed privacy policy and information handling procedures

3. Schedule 3: Patient Rights Summary: Summary of the Code of Health and Disability Services Consumers' Rights

4. Appendix A: Consent Forms: Specific consent forms for various procedures or treatments

5. Appendix B: Practice Policies: Key practice policies including appointment cancellation and complaint procedures

6. Appendix C: After-Hours Care Information: Information about emergency and after-hours care arrangements

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

New Zealand

Document Type

Consent Form

Sector

Cost

Free to use
Relevant legal definitions








































Clauses

























Relevant Industries

Healthcare

Medical Services

Primary Care

Specialist Medical Services

Allied Health Services

Mental Health Services

Dental Services

Private Healthcare

Public Healthcare

Telehealth Services

Relevant Teams

Legal

Compliance

Clinical Operations

Patient Services

Administration

Quality Assurance

Risk Management

Medical Records

Front Desk

Practice Management

Relevant Roles

General Practitioner

Medical Specialist

Practice Manager

Healthcare Administrator

Legal Counsel

Compliance Officer

Medical Director

Nurse Manager

Clinical Director

Patient Services Coordinator

Quality Assurance Manager

Risk Management Officer

Privacy Officer

Healthcare Consultant

Medical Reception Supervisor

Industries








Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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