Patient Privacy Statement

I understand that by signing this form I acknowledge and accept that:

  1. Janssen as sponsor of the Programs, has engaged the Program Managers to manage and deliver the Programs;
  2. I am enrolling on the Platform;
  3. I am also registering for a Program relevant to the Medication(s) that I am being treated with; and
  4. In order to enrol on the Platform and register into a Program, I need to provide the relevant Program Manager and Janssen with my personal information (which includes sensitive health information regarding my health and medical history).

I consent to my personal information being collected and used by Janssen and the relevant Program Manager (and any contracted service provider in its place) in accordance with its contract with Janssen and Australian privacy law for the purpose of arranging and managing the relevant Program and to provide me with services and resources relating to my condition and ongoing health needs.

I understand that the relevant Program Manager shall collect, use, disclose and store my personal information in accordance with its privacy policy and the Privacy Act 1988 (Cth). I understand that the relevant Program Manager will provide my personal information to Janssen, the Support Nurse providing the services and to any third party contracted providers engaged by the relevant Program Manager from time to time to assist in carrying out the relevant Program.

I understand that the relevant Program Manager will provide certain de-identified data to Janssen as part of the metrics of the relevant Program for research, understanding program trends and to let physicians know how the relevant Program is performing. Publication of such metrics may be used at health care professional educational symposiums and I understand that any such publication will not identify me individually.

I consent to my personal information being collected and used by Janssen in accordance with its privacy policy and the Privacy Act 1988 (Cth).  I understand that Janssen shall collect, use, disclose and store my personal information as described in the Janssen Privacy Policy, which also includes information about how I can request access to or correction of my personal information, opt out of services or communications, or make a privacy complaint.

 

FURTHER INFORMATION

If you would like to know more about the Patient Privacy Statement, Janssen’s Privacy Policy (as set out below) or any Program, or if you would like to revoke your consent to participate in any Program or access or update your personal information, please contact the relevant Program at the details set out below:

The information provided by the relevant Program does not replace or override any of the information or advice provided by your medical practitioner. This program is not an emergency service. In case of emergency, please contact your medical practitioner.

 

JANSSEN PRIVACY POLICY

[insert  policy]