Australian Capital Territory
Workers Compensation Privacy Waiver 2002 (No 1)
Notifiable instrument NI2002—207
made under the
Workers Compensation Regulations 2002, s 98  (approved protocols about certain documents)

	The following text is a privacy waiver for injured workers under 
the Workers Compensation Act 1951 and the Workers Compensation Regulations 2002:

I [person’s name] authorise each medical practitioner, or  person in charge of medical facilities, to give [insurer] any information held or gathered by the practitioner or person about my medical or factual history, or both, in relation to my injury that happened on [date].

I agree that [insurer] may give a copy of my medical information to any medical specialist, other than my nominated treating doctor, assessing my injury.

A photocopy of this authority is as valid as the original.

[signature] [date]

Simon Corbell
Minister for Industrial Relations
1 July 2002