Patient Consent Form for Work-Related Consultation

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Consent Form for Work-Related Consultation

In the case of a work-related consultation or service only including but not limited to a pre-employment medical assessment or a Workers Compensation medical assessment:

I hereby authorise Dr David Jaa, the examining or reviewing doctor, to release any information acquired, collated or ascertained as a result of the examination and consultation including a copy of my driver's licence to my employer or prospective employer or their authorised representative in relation to my employment.  I further acknowledge that information obtained by my employer about my medical history and condition from any previous medicals or other consultations may be used as part of the current assessment.

Patient Consent

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