Care Recipient Consent Form

This is a template consent form for care providers to use with their care recipients. It is not submitted to Minikai. Care providers should adapt it to their needs and have it signed by the individual or their authorised representative.

Consent Form for Collection, Use and Sharing of Personal Information

Care Provider: _____________________ (full legal name) of ____________________________ (address)

Platform: Minikai Pty Ltd ABN 32 674 548 577 trading as 'Minikai' (www.minikai.com)

Care Recipient: _____________________ (full legal name) of ____________________________ (address)

About the Platform

Minikai is an Australian technology company that provides a secure Platform designed for care providers and care recipients in the health, disability, and aged care sectors. The Platform enables care providers to record, manage, and share information about the people they support.

Through Minikai, your Care Provider and other care providers can:

• Collect and store personal and health information such as medical history, conditions, medications, and care notes.
• Share relevant information safely with other healthcare professionals or organisations when care needs to be coordinated or transferred.
• Ensure compliance with privacy and data protection laws in Australia and New Zealand by using built-in safeguards and access controls.
• Improve efficiency and quality of care by giving care providers a single source of truth for each care recipient's records.

Minikai's mission is to make it easier for care providers to deliver safe, consistent, and person-centred care, while protecting the rights and privacy of those receiving support.

Purpose of this consent form

This form asks for your consent (or the consent of your authorised representative on your behalf) to collect, store, use, and share your personal and health information through the Minikai Platform. The Platform is used by your Care Provider and other care providers to help manage and deliver effective care.

What information may be collected

Your Care Provider and other care providers may store and share the following information about you via the Platform:

• Identifying details (name, date of birth, gender, address, contact details, ethnicity, sexual orientation, cultural background, language preferences, next of kin, emergency contacts).
• Health and medical information (diagnoses, medical history, medications, allergies, test results, clinical notes, treatment plans, referrals, imaging and laboratory reports).
• Care and support needs (disability information, aged care assessments, daily living assistance, support plans, behavioural support records, incident reports, progress notes).
• Personal and social information (family details, relationships, living arrangements, employment/education history, lifestyle preferences, communication preferences, religious or spiritual beliefs (where relevant to care).
• Legal and administrative information (Medicare/NHI number, health insurance details, guardianship or power of attorney documents, advance care directives, consent records, funding and service agreements).
• Financial information (billing details, payment records, government funding or subsidy details (e.g. NDIS, My Aged Care).
• Multimedia records (photographs, audio or video recordings used for identification, care planning, or clinical purposes).
• Technology and usage data (information about how you or your representatives interact with the Platform (for example, log-in activity, device and access records, communications exchanged through the Platform).
• Any other information, documentation or materials that may be reasonably required by care providers to administer, coordinate, or manage your care.

We understand that some of the information collected is highly sensitive. It will only be collected where relevant to your care, or where required by law, and will be handled in accordance with Australian and New Zealand privacy laws. Safeguards, including secure storage and access controls, are in place to protect your information. Your information will never be used for purposes unrelated to your care without your consent, unless required by law.

How your information may be used

Your information will be used to:

• Provide you with safe and effective care.
• Record, monitor, and update your care.
• Share information with other health and care providers when necessary to coordinate your care, including referrals, handovers, or when your care provider changes.
• Comply with legal and regulatory requirements that apply to health and disability services.
• Communicate with you, your authorised representative, or your nominated contacts about your care and services.
• Support funding, billing, subsidy, and reimbursement processes (for example, NDIS, My Aged Care, ACC in NZ, or private health insurance).
• Conduct quality assurance, service improvement, and safety monitoring activities (such as auditing or reviewing care practices).
• Train and support care provider staff (using de-identified information where possible).
• Maintain the secure and effective operation of the Minikai Platform (for example, system monitoring, troubleshooting, and technical support).
• Any other use directly related to the provision or coordination of your care.

Who may access or receive your information

Your personal and health information may be accessed or received by:

• Your current care provider and their authorised staff.
• Other health and care providers who are directly involved in your treatment or support, including but not limited to doctors, specialists, hospitals, nurses, allied health professionals, and aged or disability care providers. This may also include potential health and care providers, where information is reasonably required to determine whether they can deliver appropriate care to you.
• Emergency services or other relevant organisations, where information needs to be shared to protect your life, health, or safety, or the safety of others.
• Regulatory bodies, government agencies, or funding authorities, where disclosure is required or authorised by law (for example, reporting obligations in aged care, disability services, or public health).
• The team at Minikai Pty Ltd may also need to access your personal and health care information to facilitate the operation, support and secure functioning of the Platform.

1. Storage and protection of your information and limitations

Your information will be securely stored within the Platform. Minikai Pty Ltd complies with the privacy laws of Australia and New Zealand, and will take reasonable steps to protect your information from unauthorised access, loss, misuse, or disclosure.

While Minikai takes security and privacy seriously, no system can be guaranteed as completely secure. To the extent permitted by law, Minikai Pty Ltd is not responsible for any unauthorised access, loss, misuse, or disclosure of your information that arises from:

• Actions or failures of your Care Provider or other third parties who are authorised to access your information.
• Circumstances outside Minikai's reasonable control (for example, cyber-attacks, technical failures, or unlawful activity).
• Your own sharing of information or access by persons you have authorised.

Each care provider using the Platform is responsible for:

• Ensuring that they collect, use, and share your information lawfully and in compliance with their own privacy and professional obligations.
• Managing who within their organisation is authorised to access your information.
• Ensuring that only relevant and accurate information about you is entered into the Platform.
• Responding to your requests to access or correct your information, and managing your withdrawal of consent, in coordination with the Platform's administrators.

Your information may be stored in Australia, New Zealand, or other locations using reputable third-party providers. Minikai will ensure that any overseas recipient provides privacy protections substantially similar to those under applicable privacy laws.

2. Withdrawal of Consent

You may withdraw your consent at any time by notifying your Care Provider in writing. Withdrawal will not affect any use or disclosure of your information that has already occurred in accordance with this form.

3. Contact and Complaint Information

If you have questions about this consent form or wish to access or correct your information, you can contact your Care Provider or Minikai at privacy@minikai.com. If you are not satisfied, you may contact the Office of the Australian Information Commissioner (www.oaic.gov.au) or the Office of the Privacy Commissioner NZ (www.privacy.org.nz).

4. Capacity and Representation

It is the duty of your Care Provider to assess your capacity to provide consent. If you are unable to provide consent yourself due to age, disability, illness, or any other reason, this form may be signed on your behalf by:

• A parent or guardian (for minors).
• A person holding medical or enduring power of attorney.
• Another legally authorised representative.

5. Acknowledgement and consent to collection, use, storage and sharing of my information

By ticking the box below and signing this form, I, or my duly Authorised Representative, confirm that I have read and understood this consent form. I understand how my personal and health information will be collected, used, stored, and shared with my Care Provider and with other care providers where necessary to support and coordinate my care.

☐ I consent to my information being collected, used, stored, and shared as described in this form.

☐ For Authorised Representatives only: I consent on behalf of the care recipient, as their Authorised Representative, for their information to be collected, used, stored, and shared as described in this form, and I confirm that I am legally permitted to provide this consent.

Care Recipient Name: ____________________________

Signature: ____________________________

Date: ___________________________

Authorised Representative (if applicable): Name: ____________________________ Relationship/Authority: ____________________________ Contact Number: ____________________________ Address: ____________________________ Signature: ____________________________ Date: ___________________________