ABC SERVICE CONSENTS

Participant Details

Participant Name *

Date of birth *

Person providing consent

Person providing consent name *

ParticipantLegal GuardianChild Representative Case Manager or OOHC Agency employee with delegated responsibility from the minster.

How long are you providing the below consent for?

Until further noticeUntil the end of the NDIS plan periodUntil a set date

Australian Behaviour Consultants (ABC) Report(s) Consent

I give permission for ABC to conduct assessment activities and write reports i.e., Behaviour Support Plan for the participant.

I give my permission for ABC to:

Read my/the participants records.
Observe me/the participant.
Speak with me/the participants support team.
Train my/the participant support team in the behaviour support plan.

I understand that the purpose of these activities is to gather information about me/the participant for the development of reports, i.e., behavioural data collection, medical history, and incident reports that will assist to develop a more thorough report and/or plan.

I understand Behaviour Support Plans may contain recommended restrictive practices and I am able to withdraw this consent if I choose to at any stage.

Consent to share information

I am the person/person responsible/Guardian for the above-mentioned NDIS Participant and hereby give permission for ABC to exchange/release any or all information pertaining to me/the participant.

The following is a list of example organisations etc. with whom ABC may exchange/release information,

NDIS service providers such as your accommodation provider, support workers, day program service provider.
NDIS therapists such as your occupational therapist, physiotherapist, speech therapist.
Allied Health Professionals such as your General Practitioner, Psychologist, hospital staff.
NDIS Quality and Safeguards Commission.
Department of Communities and Justice (DCJ).
NSW Department of Education (or other education department).

List below any person/organisation or department you do not permit ABC to exchange information with:

I understand that I have the right to revoke this consent at any time by emailing info@abcbs.com.au

Service Continuation

Upon initial engagement ABC will commence support logs, case notes and claiming. The behaviour support service will continue until I/the participant inform ABC to discontinue the service in writing and end the “My Provider” arrangement (If required) with the NDIA by calling the NDIA on 1800 800 110.

Each NDIS plan period ABC will provide a new schedule of supports and consents form to inform me/the participant and facilitate any change of service or consent. If no change or new information is received the service will continue as outlined in the schedule of support.

Agreement

Name *

Date *

Signature *

Clear