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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.