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Client Authorisation
1. Purpose & Consent
1. Purpose & Consent
• Provider: DisabilityPlus. • Goal: To process applications for specialist mental health funding. • Method: Submission of a Clinical Exceptionality Report or an Individual Funding Request (IFR) to the NHS. • Rationale: The service is a specialist “lived experience” model that sits outside NHS Talking Therapies.
2. Information Sharing
2. Information Sharing
By signing, this form you authorise sharing relevant clinical and personal data with: 1- General Practitioner (GP): To notify them of the request and obtain medical history if needed. 2 – NHS Integrated Care Board (ICB) or NHS HealthBoard (Wales): Specifically, the IFR or IPFR Panel or Mental Health Commissioning Team. 3 – Shared Data Includes: Disability impact on daily living, initial mental health assessment data, and the rationale for the use of this peer-to-peer model.
3. Patient Rights
3. Patient Rights
1 – Voluntary: Consent is given voluntarily. 2 – Withdrawal: Consent may be withdrawn at any time, though this may result in cessation of funding application. 3 – Protection: Data is processed in accordance with UK GDPR and clinical confidentiality policies.
Declaration and Signature
4. Declaration & Signature
“I confirm that I have read and understood the information above. I give my express permission for DisabilityPlus to contact my GP and the relevant NHS Commissioning/IFR teams to share clinical information for the purpose of the funding panel making a decision on the request for my mental health counselling support.”
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