New patient registration

• You accept that Franklin Day Surgery may access your external health records (e.g. from public hospital and GP) to provide appropriate care for you.
• Franklin Day Surgery may use the above details including email to advise of appointments, send correspondence and patient satisfaction surveys.
• From time to time, we work with other trusted affiliate healthcare practices and share patient diagnostic testing equipment when providing patient care. They may access your patient information through this equipment when providing this care. We have strict polices and non-disclosure agreements to prevent unauthorised access to and misuse of patient information.

ACC CLAIMS

• Contract Claim: If your medical operation/procedure is an ACC Contract Claim, ACC will pay the hospital directly for all hospital and specialist’s costs
• Part ACC/Part Insurance: Proof of prior approval is required prior or on admission for the portion of your procedure that is covered by insurance. For further details on ACC reimbursement practices please ask your ACC case manager.

PAYMENT OF HOSPITAL COSTS

• If you have no insurance, you will be required to pay the full estimated cost of the operation/procedure on or before admission. If internet banking is done within 3 days prior to your admission, you may need to provide proof of the transaction prior to admission. We strongly recommend you contact our bookings team
• 09 9091500 or 0800 222 024 for an estimate of the hospital costs prior to admission.
• If you have prior approval with a private health insurer, you will need to pay any expected shortfall on or before admission.
• You understand and give consent that relevant information may be supplied to an external credit reporting agency to obtain a credit report.
• You agree you are responsible and will pay for all costs incurred in connection with your treatment.
• You understand that Franklin Day Surgery may notify a credit reporting agency and/or instruct a debt collection agency should you default on any payment due by you to Franklin Day Surgery.
• You understand that any collection and/or legal costs incurred in recovering any debt will be charged to you.
• Southern Cross Insurance (SX) Members: By signing this form, you authorise Franklin Day Surgery to obtain prior approval, share information with SX and process your claim as an affiliated provider.

PERSONAL PROPERTY

• We request you leave all valuables at home. Should you bring such items in with you, you understand and agree that Franklin Day Surgery is not and will not be responsible for loss of or damage to any personal property (including jewellery, dentures, watches, rings, glasses) which you may bring into the hospital

PRIVACY

• We may share your information with other healthcare professionals and agencies involved in your care and treatment. It is normal practice to give necessary and relevant information about you to: your GP, the health care professional who referred you, your community nurse, or other healthcare professionals involved in your ongoing care.
• We may also provide your information to the Ministry of Health and other government agencies that require us to provide information for administrative, legal, contractual, statistical, research or public health purposes.
• We treat your personal and health information as confidential and have processes to keep your information protected.