MEDICAL INFORMATION – MAC STUDENTS

CONFIDENTIAL

INTRODUCTION

Many chronic medical conditions can produce acute emergencies or interact adversely with injuries. As the patient in these situations is often unable to tell his or her attendants of these conditions (due to unconsciousness etc.), it is helpful for staff and students to disclose such conditions to the local Nominated First Aid Officers in order for an appropriate First Aid Response Plan to be developed. The Nominated First Aid Officer will keep this information confidential, but may disclose it in confidence to persons who need to know in order to protect your health, safety or well-being.

Please advise the college of any significant change in your medical status (e.g. new disease, new treatment etc.)

COMPLETION OF THIS PAGE AND YOUR SIGNATURE AT THE END OF THIS DOCUMENT IS COMPULSORY

Name:

Date of birth:Gender: Male / Female

Emergency Contact Person
Name: / Surname:
Phone number: (h) / Phone number: (m)
Email: / Relationship to student:

PLEASE CONTINUE OVER THE PAGE TO

COMPLETE THE FORM AND SIGN.

COMPLETION OF THE FOLLOWING SECTIONIS VOLUNTARY

but it is in your best interests for us to

care for you in an emergency.

Details of known medical condition(s) including allergies

Typical symptoms or presentation requiring first aid response

Recommended first aid response if symptoms occur

Regular medications taken

CONSENT TO CONTACT TREATING DOCTOR AND DISCLOSE PRIVATE HEALTH INFORMATION TO OTHERS WITH A NEED TO KNOW

Name of personal doctor:

Phone:Address:

PLEASE SIGN

I understand that this information will be held by the Nominated First Aid Officer and may be released only to those with a need to know, such as my teacher, ambulance officers or a medical practitioner.

Signed: Date:

Mary Andrews College, Level 1 St Andrew’s House, 464-480 Kent Street, Sydney NSW 2000 Ph 1300 590 531 Fax (02)9261-2864