Please ensure you deidentify the data contained in any documents you upload including staff names (we suggest the use of role titles as an alternative). 

By completing this form you are consenting to allow WVPHN to store the information you provide on Practice Connect and this information may be logged on WVPHN Customer Relationship Management System for the purpose of achieving successful stakeholder engagement. Responses to this form will be accessed by Practice Facilitation team and other key staff to support your practice in meeting PIP QI compliance.  In addition the information provided may be shared externally to WVPHN, as we share your success story with other practices.

WVPHN is committed to protecting your privacy and is bound by the Privacy Act 1988 (Cth), Privacy and Data Protection Act 2014 (VIC), Health Records Act 2001 and complying with our obligations under the Australian Privacy Principles.