Common Client Layer Consent Form

What is the Common Client Layer?

The information we collect about you is stored in an electronic system, known as CRISSP that is owned by the Department of Human Services. Normally, none of the details we collect about you when you receive a service from us can be seen by anyonewho provides you with other services. If you deal directly with the Department of Human Services or another service providerfunded by the Department you need to give the same information all over again, such as name, date of birth, address andother contact details.

The Common Client Layer will let all the workers you deal with see a few basic details such as your name and contactinformation. Other personal information we record on CRISSP remains confidential between us and you. The Common ClientLayer will mean that you no longer have to give your details to every service that works with you.

Information about me should be visible to authorised workers in the Department of Human Services and other services so that they can provide better services to me. *

I agreeI disagree

I am completing this form: *

For myselfOn behalf of someone else as an authorised representative

Your details

Your first name *

Your surname

Relationship to the individual receiving service

CRISSP/Common Client Layer

We provide services that are paid for by the Department of Human Services. The Law protects the privacy of the informationwe collect about you when we provide these services.

You may already be receiving services directly from the Department or from some of its other service partners. We all wantto work together to make sure that we can best meet your needs.

We need your permission to allow other workers to see a small number of your details that will help us work moreclosely together.

The information that other workers would see is known as the ‘Common Client Layer’.

What details can be seen in the Common Client Layer?

If you agree, the following details will be available to workers you deal with. This includes Department of Human Servicesworkers and your workers from some other agencies who are funded by the Department.

Who the information is about	Common Client Layer Information
You	Name, address, contact details, identification number, date of birth, sex, preferredlanguage, need for interpreter, need for special communication methods, andindigenous status
You, if you are less than 18 years old	Information about household members, immediate family members and carers -name, address, contact details, role, and relationship to you
Your authorised representatives (if any)	Name, address, contact details, role, and/or relationship to you
Workers you deal with	Name, organisation and contact details of the key or lead workers who provideyou with services
Operational information (if applicable)	Safety and operational information for workers, if applicable and necessary

Who will be able to see my Common Client Layer details?

Only your workers and their supervisors.
Other workers who work with you.

Why should I agree to make my Common Client Layer details visible?

It will make it easier for you to contact your worker.
To allow all your workers to know about any changes. Whether urgent, serious or just a change of address, the informationcan be quickly given to workers who need to know.

What if I don’t agree to make my details visible?

You might need to provide the same information to a number of people.
There is a risk that workers may get wrong information.
Workers may not find out about changes until much later.
There might be delays if your worker is not available.

What if I change my mind?

Tell your worker who can arrange for your details to be no longer available.

Please sign here

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