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Consent to share GP provider details for the Cancer Screening Project

Brisbane North PHN is collecting the information below to facilitate reporting on your practice’s cancer screening project and to request relevant data from Queensland Health’s Cancer Screening Unit (CSU). We will use your information solely for project reporting and to provide feedback to your practice.

Practice & Contact Details

Maximum 255 characters

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Maximum 255 characters

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3.  

Role

* required

EOI Update

4.  

Have any of the GP details in your original EOI paperwork changed (i.e. names, provider numbers)?

* required

Data Use Statement & Consent

As part of your practice participation in the Cancer Screening Project, Brisbane North PHN are able to coordinate collection of relevant data from Queensland Health’s Cancer Screening Unit.

The purpose of this information is to support the evaluation of the quality improvement activity undertaken by your GPs and your practice. To do this the Cancer Screening Unit requires the Provider number and name of the GPs participating to be provided by Brisbane North PHN.

Please confirm that:

Participating General Practitioners are aware and consent to their details (full name and provider number) being collected by Brisbane North PHN and shared with Queensland Health’s Cancer Screening Unit (CSU) to generate provider-level performance data for the purpose of informing quality improvement activity.

5.  

Do you agree to the Data Use Statement and Consent?

* required