OIA REQUEST

Received:

09 February 2021
Due:

09 March 2021
Response Date:
03 March 2021
Subject:

Complaint Procedure WBOP PHO

In response to your request under the Official Information Act, please find our response below:

1.
Complaint procedure for your contractor –  Western Bay of Plenty Primary Health
Organisation.

Please find attached the Western Bay of Plenty Primary Health Organisation’s
Complaints Management Policy.  This is currently under review, therefore, is in draft
form at this time.

2.
What is the minimum required documentation regarding eligibility/identity required by
GP practices that are subsidised by the WBOPHO.

Information held by a contractor to an OIA organisation is deemed held by that
organisation if it is in the contractor's capacity as contractor.  WBOP PHO is contracted
by Bay of Plenty DHB.

WBOPPHO and its aligned General Practices observe the national Enrolment
Requirements when enrolling a new patient/s.  This requires:
•  establishing the identity of the person, and
•  verification of the persons entitlement to access publicly funded health services
by establishing that the person is;
o  a New Zealand citizen, or
o  has a right to permanently reside in New Zealand, or
o  holds a work visa for two or more years, or
o  is aged 17 years or younger and their parent meets one of the above criteria.

This identity and eligibility verification is usually evidenced through production of a Birth
Certificate, New Zealand passport, passport from country of birth with a visa attached
and/or a NZ Driver’s License. In the absence of photo ID, two other forms of identity
verification are required.  Please find the MoH enrolment requirements document
attached.

Please note that this response may be published on our website as part of  our proactive
release practice.

Yours sincerely

DEBBIE BROWN
Senior Advisor Governance and Quality

P OLICY STANDARD & PROCEDURE
No:
BP 001
WBoP

Page 1 of  6

PHO log
Title: Complaints Management
Date of Issue:
Authorised By:
Date Authorised:
Date of Review:

BACKGROUND
The complaint mechanisms under the Health and Disability Commission Act 1994, have become the
primary vehicle for dealing with complaints about the quality of health care and disability services in
New Zealand. The purpose of this Act is to promote and protect the right of health consumers and
disability  services  consumers and to that end, to facilitate  the fair, simple, speedy  and efficient
resolution of complaints relating to infringements of those rights.

INTRODUCTION
The Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights)
Regulations 1996 applies  to all providers of health and disability services. The Code sets out 10
rights, including the right to be treated with respect, to be free from discrimination or exploitation, to
dignity and independence, to services of an appropriate standard, to give informed consent, and the
right to complain.

SCOPE
●  The  enrolled population of the WBOP PHO who receive health services from PHO contracted
providers
●  Patients who receive health service directly from the WBOP PHO
●  “PHO customers” - those contracted providers and others when receiving services from the PHO
office.

PURPOSE
●
To resolve as many issues as possible to the complainant’s  satisfaction  in a fair, simple,
speedy, and efficient manner.
●
To use the Complaints  policy and process as a tool to pro-actively promote what  is the
expected consumer service behaviour that al  WBOP PHO staff should display

POLICY
The WBOP PHO is commit ed to the delivery of high-quality  service. There are 3 key groups of
customers that the WBOP PHO provides services to, either directly or indirectly:

While it is most appropriate that complaints are dealt with at the provider level, the patients are able to
raise a complaint with the WBOP PHO.

The  WBOP  PHO is commit ed to promoting a  culture of continuous quality improvement within  its
providers and the WBOP PHO office. Part of promoting this culture is responding appropriately to any
complaint in a way that ensures that information identified as part of complaint investigation is used to
improve the services the WBOP PHO, and its providers, deliver.

WBoP PHO: Policy Standard: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

POLICY STANDARD & PROCEDURE
No:
BP  001
WBoP PHO

Title:   Complaints Management
Page   2 of 6

PROCEDURE

1.
PATIENT RELATED COMPLAINTS
A patient related complaint applies to any complaint received by the WBOP PHO relating to services
provided by the WBOP PHO or by any of its contracted staff.
The process of communication and timeframe for dealing with complaints is specifical y set out in the
Code of Health and Disability Services Consumer Rights, Right 10:  Page 5 &  6
The  WBOP  PHO’s response to any patient complaint shall  comply  also  with all the other relevant
rights in the Health and Disability Code of Patient Rights when dealing with complaints.
Complaints may be made in any way that is appropriate to the patient.

On Receipt of a Patient Complaint

●
All written complaints should be addressed/forwarded to the Chief Executive Of icer.

●
Any complaints received verbally are to be documented on the complaint’s form and forwarded
to the Chief Executive Of icer.

●
On receipt of the complaint the Chief Executive Of icer shall determine whether the complaint
has been previously raised directly with the provider concerned.

If not, The Chief Executive Officer may suggest that this occurs.

If for any reason the patient does not wish to raise the complaint directly with the provider, the
PHO wil  pursue the complaint on their behalf.

●
All complaints will be registered on the WBOP PHO complaints register.

●
All complaints shall be acknowledged within 5 working days of receipt of the complaint.

The  provider  concerned wil  be informed that the PHO has received  a  complaint.  For more
minor complaints this may occur at the same time as any investigation takes place.
   In the unlikely event that a provider does not wish to engage in the WBOP PHO complaints
process, the Chief Executive Of icer shall advise the Chair of the Clinical Commit ee.

If following the engagement of the Chair of the Clinical Committee, the provider remains unwilling
to participate in the process, the WBOP PHO shall advise the patient of their right to complain to
the Health and Disability Commissioner

When dealing with complaints it is important to ensure that the privacy of
both the patient and the provider is protected

WBoP PHO: Policy and Procedure: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

POLICY STANDARD & PROCEDURE
No:
BP  001
WBoP PHO

Title:   Complaints Management
Page 3 of 6

Investigating the Complaint

●
Al  complaints wil  be investigated by the Chief Executive Of icer or a delegated person.

●
Where it is considered appropriate, the Chief Executive Officer may seek and consider input,
from the Clinical Commit ee and/or other appropriate individuals/organisations

Where the Chief Executive Of icer engages the Clinical Committee, the GM and the Chair of
the Clinical Committee may establish a sub-group of the Commit ee which would be made up
of the most appropriate people to assist with the processing of the complaint.

This group would include the Chair of the Clinical Commit ee and would also include a
representative of any professional group that the complaint relates to. The subgroup may also
opt on those with expertise relevant to the specific complaint.

●
If the complaint is considered to be of a serious nature, the Chief Executive Officer shall inform
the Chairs of the WBOP PHO Board and the Clinical Committee. After initial investigations,
together they can form a judgement as to whether any external authority needs to be notified.

●
The WBOP PHO wil  ensure that the patient’s complaint and the actions of the WBOP PHO
regarding that complaint are documented.

Informing the Patient

The  WBOP  PHO  shall  acknowledge  the  patient  within 5 working days of  the  receipt  of a
complaint, unless it has been resolved to the satisfaction of the patient within that period.

The patient shall be informed of any relevant internal and external complaints’ procedures, including
the availability of:


Independent advocates provided under the Health and Disability Commissioner Act 1994; and


The Health and Disability Commissioner

The  patient  receives all information held by the WBOP  PHO  that is,  or may be  relevant,  to the
complaint.

Within 15 working days of receiving the complaint, the WBOP PHO must decide whether the WBOP
PHO:
●
Accepts that the complaint is justified; or
●
Does not accept that the complaint is justified
or

WBoP PHO: Policy and Procedure: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

POLICY STANDARD & PROCEDURE
No:
BP  001
WBoP PHO

Title:   Complaints Management
Page   4 of 6

If the WBOP PHO decides that more time is needed to process the complaint
●
The WBOP PHO will determine how much additional time is needed; and
where additional time is more than 20 working days, inform the patient of that determination
and of the reasons for it.
As soon as practicable, after the WBOP PHO decides whether or not the complaint is justified, the
PHO must inform the patient of:
a)
The reasons for the decision; and
b)
Any actions the provider proposes to take; and
c)
Any appeal procedure the provider has in place.

2.
COMPLAINTS FROM OTHER ‘PHO CUSTOMERS’
Al  providers within the PHO are “customers” when they receive services from the WBOP PHO. To
ensure best practice for all complaints; any complaint relating to the services that the WBOP PHO
provides, will be dealt with using the timeframes and process that relates to patient complaints:

●
Al  complaints wil  be registered on the WBOP PHO complaints register.

●
All complaints will be treated as confidential.

●
If the complaint is considered to be of a serious nature the Chief Executive Of icer will inform
the Chair of the WBOP PHO Board.

●
Al  complaints wil  be investigated by the Chief Executive Of icer or a delegated person.

●
The WBOP PHO shall acknowledge the customer within 5 working days of the receipt of a
complaint, unless it has been resolved to the satisfaction of the customer within that period

●
The complaint and the actions of the WBOP PHO regarding the complaint are documented

Within 15 working days  of receiving the complaint, the  WBOP  PHO  must  decide whether the
WBOP PHO:

●
Accepts that the complaint is justified; or
●
Does not accept that the complaint is justified

If the WBOP PHO decides that more time is needed to process the complaint
●
The WBOP PHO will determine how much additional time is needed; and
where additional time is more than 20 working days, inform the patient of that determination
and of the reasons for it.

As soon as practicable, after the WBOP PHO decides whether or not the complaint is justified, the
WBOP PHO must inform the customer of:
a)
The reasons for the decision; and
b)
Any actions the provider proposes to take; and
c)
Any appeal procedure the provider has in place.
_______________

WBoP PHO: Policy and Procedure: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

POLICY STANDARD & PROCEDURE
No:
BP  001
WBoP PHO

Title:   Complaints Management
Page 5 of 6

Health and Disability Commissioner Act 1996 Code of Rights

DEFINITION:  RIGHT 10 - Right to Complain

1)
Every consumer has the right to complain about a provider in any form appropriate to the
consumer.
2)
Every consumer may make a complaint to:
a)
The individual or individuals who provided the services complained of; and
b)
Any person authorised to receive complaints about that provider; and
c)
Any other appropriate person, including:
i.
An independent advocate provided under the Health and Disability
Commissioner Act 1994; and
ii.
The Health and Disability Commissioner.
3)
Every provider must facilitate the fair, simple, speedy, and efficient resolution of complaints.
4)
Every provider must inform a consumer about progress on the consumer's complaint at
intervals of not more than 1 month.
5)
Every provider must comply with all the other relevant rights in this Code when dealing with
complaints.
6)
Every provider, unless an employee of a provider, must have  a complaints procedure that
ensures that –
a)
The complaint is acknowledged in writing within 5 working days of receipt, unless it has
been resolved to the satisfaction of the consumer within that period; and
b)
The consumer is informed of any relevant internal and external complaints procedures,
including the availability of:
i.
Independent advocates provided under the Health and Disability Commissioner
Act 1994; and
ii.
The Health and Disability Commissioner; and
c)
The consumer's complaint and the actions of the provider regarding that complaint are
documented; and
d)
The consumer receives all information held by the provider that is or may be relevant
to the complaint.
7)
Within 10 working days of giving writ en acknowledgement of a complaint, the provider must:
a)
Decide whether the provider:
i.
Accepts that the complaint is justified; or
ii.
Does not accept that the complaint is justified; or
b)
If it decides that more time is needed to investigate the complaint:
i.
Determine how much additional time is needed; and
ii.
If that additional time is more than 20 working days, inform the consumer of
that determination and of the reasons for it.
8)
As soon as practicable after a provider decides whether or not it accepts that a
complaint is justified, the provider must inform the consumer of -
a)
The reasons for the decision; and
b)
Any actions the provider proposes to take; and
c)
Any appeal procedure the provider has in place.

WBoP PHO: Policy and Procedure: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

POLICY STANDARD & PROCEDURE
No:
BP  001
WBoP PHO

Title:   Complaints Management
Page 6 of 6

Documentation:

●
Complaints form               -   document numbers needed
●
Disciplinary process
as above
●
Investigation Process
as above

Cross Reference(s)

Health and Disability Commissioner Act 1994
Health and Disability Commissioner Act 1996 Code of Rights
Privacy Act 2000
Health information Privacy Code 1994 and amendments
Health Customer Service, Consumer Rights,

WBoP PHO: Policy and Procedure: Complaints Management
Note: the electronic version of this document is the most current. No printed copy cannot be assumed to be the current version.

Enrolment Requirements for
Contracted Providers
and
Primary Health Organisations
_________________________________________

Version 4.1

6 November 2018

Revision History
Version
Changes from previous version
Date
4.0
1.  Updated introduction
November 2017
2.  Additional information about the use of NES in the enrolment
process
3.  Addition of steps for managing health identity
4.  Re-ordering of steps in the enrolment process to reflect workflow
in practices
5.  Clarification of the split between maintaining identity and
managing enrolment in NES
6.  Clarification of the processes required following changes in
Contracted Provider and/or PHO
7.  Final legal review by Buddle Findlay
4.1
1.  Updated introduction
October 2018
2.  Further clarification around NHI as the source of truth for patient
demographic information
3.  Change to rule around no GMS deductions for newborns with a
“B” code status to no GMS deductions for all newborns for a
period of three months from the newborn’s date of birth.

Page 2 of 34

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link to page 28 link to page 29 link to page 30 link to page 35 link to page 38 link to page 40

  Introduction
The refreshed New Zealand Health Strategy: Future Direction 2016 sets out the framework for the health system to
address the significant demands on its services and on the health budget. Its key themes for health care services –
people-powered,  closer  to  home,  value  and  high  performance,  one  team  and  smart  system  –  are  cornerstones  in
establishing a health sector that understands people’s needs and provides services that are integrated across sectors,
emphasising  investment  early  in  life,  maintaining  wellness,  preventing  illness,  and  providing  support  for  the  final
stages  of  life.  A  strong  primary  health  care  system  is  central  to  improving  the  health  of  New  Zealanders  and
implementing this framework.
The Primary Health Care Strategy  (the Strategy) was developed in 2001 to provide a  clear direction for the  future
development of primary health care in New Zealand.  Its implementation signalled a new direction in primary health
care with the development of Primary Health Organisations (PHOs), capitated population-based funding, and primary
health care services that are organised around the needs of a defined population.
Enrolment  is  a  fundamental  and  enabling  principle  of  the  Strategy  as  it  describes  the  process  by  which  a  person
formalises their longitudinal relationship with their chosen Contracted Provider.
Enrolment lays the foundation for a pro-active, co-ordinated population-based approach to preventive care, chronic
disease management and systematic practice-level performance measurement and quality improvement.
Enrolment  underpins  accountability  by  defining  the  population  for  which  the  Contracted  Provider  and  PHO  is
responsible and funded for.  Therefore  it  is  important  that robust  enrolment  processes are followed to  ensure the
accuracy and timeliness of enrolment data.
National Enrolment Service (NES)
NES is the national enrolment service hosted by the Ministry of Health and is the master source of truth for a person’s
enrolment status.   The Contracted Provider’s Practice Management System (PMS) uploads to NES via a secure web-
based service and NES links directly to the Ministry of National Health Identity (NHI) platform.
NES provides the capability to support Contracted Providers via a direct link from NES to the Ministry of Health hosted
National Health Index (NHI) identity platform which can be used to assist with assessment of a person’s entitlement
to enrol and eligibility for funded healthcare.   A person’s demographic attributes are sourced and maintained from
the NHI being the master source of truth for such data.

All aspects of this Referenced Document are complete and will be applied from the date of agreement by the PHO
Services Agreement Amendment Protocol (PSAAP) Group (the NES Start Date).
Page 5 of 34

  Enrolment Overview
A person enrols with their preferred Contracted Provider of First Level and Urgent Care Services and becomes part of
a  PHO’s Enrolled Population  through the contract the PHO has  with a  Contracted  Provider.   A person can only be
enrolled with one Contracted Provider and be part of one PHO’s Enrolled Population at any one time.
The table below summarises the requirements for enrolment with a Contracted Provider of a PHO.
Confirm Identity of Person
Contracted Providers are required to follow the protocols relating to patient
identity management outlined in the NHI Best Practice guidance provided by
the Ministry, using the data provided in a person’s NHI record as the central
source/repository  of  identity  information.    A  person’s  NHI  data  will  be
available via the NES integration with the Contracted Provider’s PMS.
Assess Eligibility to receive publicly  Contracted Providers (along with all other publicly funded health providers)
funded health services
are required to assess the eligibility of the person to receive publicly-funded
health and disability services as per the Eligibility Direction 2011 published
in the Gazette.
Assess Entitlement to Enrol
Contracted Providers are required to assess the entitlement of the person
to enrol by having the person confirm they:
  intend  to  use  the  Contracted  Provider  as  their  regular  and  on-going
provider of First Level Services;
  intend to reside permanently in New Zealand (resident in NZ for more
than 183 days in the next 12 months); and
  are  not  receiving  long-term  continuous  and  exclusive  care  through
another  funding  agreement  e.g.  Department  of  Corrections  (prison
including remand), NZ Defence Force.
Complete Enrolment Process
Contracted Providers are required to ensure the enrolling person completes
a hard copy or electronic format Enrolment Form.  The Enrolment Form must
include:
  the enrolment minimum dataset (refer section 3.6)
  an eligibility declaration
  an entitlement declaration
  the My Agreement to the Enrolment Process statements
  an acknowledgment of Use of Health Information Statement
  hand  signature  (ink  or  digital  pen)  of  enrolling  person  (or  authorised
person) and date of signing
NB. Although “consent to transfer records” is not a mandatory requirement
on the Enrolment form it is required as part of Foundation Standard which
is a minimum requirement within the PHO Services Agreement.
Enrolment Forms in electronic format must be able to be printed in a format
that presents all Enrolment Form requirements.
Enrolment  Data  Collection  and  Contracted  Providers  are  required  to  record  accurate  information  about
data held in NES
Enrolled Persons in their PMS which will upload enrolment information to
the NES in accordance with the agreed data specifications and business rules
in  the  Business  Requirements:  National  Enrolment  Service  and  Capitation
Based Funding Referenced Document.
NES will be the ‘single source of truth’ for enrolment data.

Page 6 of 34

  Enrolment Process
  Confirming Identity of Person
If the person presenting for services for the first time is unknown to the Contracted Provider best practice is to confirm
the person is who they say they are by sighting documentation with photo ID eg. Driver’s Licence or Passport.
It  is  the  person’s  responsibility  to  provide  accurate  and  truthful  information  to  the  Contracted  Provider  when
presenting  for  services  and/or  seeking  to  enrol  and  the  Contracted  Provider  is  entitled  to  rely  on  appropriate
information provided by the person seeking to enrol.
If  the  primary  confirmation  of  identity  includes  photo  ID  then  that  alone  is  sufficient.    If  this  is  not  available  then
sighting of two supplementary forms of ID is recommended eg. credit card, invoice with name, other  forms of non-
photo ID with the person’s name included.
  Assessing Eligibility to Receive Publicly Funded Services
Having confirmed the identity of the person seeking to enrol, Contracted Providers are required to assess the person’s
eligibility to receive publicly funded health services, which involves an eligibility declaration by the person.
The Ministry of Health has compiled relevant material to assist Contracted Providers to assess eligibility  in the link
below:
http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services/guide-eligibility-
publicly-funded-health-services
This material is recommended to Contracted Providers and PHOs as it clearly sets out how to meet the Government’s
Eligibility Direction.
Refer to Appendix 1 Eligibility Guide for further detail on determination of eligibility.
  Contracted Providers are to take all reasonable steps to ensure that only persons that are eligible to enrol are
recorded in their PMS as enrolled.
  It is recommended that Contracted Providers sight the person’s documents in order to assess eligibility.
  It is the person’s responsibility to provide appropriate documentation against which the eligibility assessment is
made by the Contracted Provider.
The Eligibility criteria questions are required to be completed by the person seeking enrolment in the format outlined
in Appendix 4 Sample Enrolment Form.
Contracted  Providers  are  entitled  to  rely  on  the  documentation  provided  by  the  person  seeking  to  enrol  unless  it
patently appears fraudulent.
NB. If the Contracted Provider has knowledge that a person is no longer eligible to be enrolled, the Contracted Provider
must dis-enrol the person by changing the enrolment status in the PMS to a Registered User or Casual User without
delay.  This will upload to NES. A note should be made in the  Daily Record stating the reason why the person is no
longer eligible to be enrolled.
  Assessing Entitlement to Enrol and to remain Enrolled
Having confirmed the eligibility for publicly funded services of the person seeking to enrol, Contracted Providers are
required  to  assess  the  person’s  entitlement  to  enrol,  which  involves  an  entitlement  declaration  by  the  enrolling
person.
It is the enrolling person’s responsibility to provide accurate and truthful information to the Contracted Provider when
presenting for services and/or seeking to enrol and the Contracted Provider is entitled to rely on information provided
by the person seeking to enrol.
A person is entitled to enrol (or remains entitled to be enrolled) with a Contracted Provider of a PHO if he/she:
  intends to use the practice as his/her regular and ongoing provider of First Level Services; and
  intends to reside permanently in New Zealand (resident in NZ for more than 183 days in the next 12 months);
and
  is  not  receiving  his/her  long-term  continuous  and  exclusive  care  through  another  funding  agreement  e.g.
Department of Corrections (prison and remand), Defence Force.
Page 7 of 34

The Entitlement declaration is set out in Appendix 4 Sample Enrolment Form.
If a person is declined enrolment because he/she does not intend to reside permanently in New Zealand he/she may
lodge an appeal  with the Enrolment Appeal Office within 30 days of being declined enrolment on the basis of not
meeting the residency requirement.
An Enrolment Appeal Form is included in Appendix 6 Enrolment Appeal Form.
NB. If the Contracted Provider has knowledge that a person is no longer entitled to be enrolled, the Contracted Provider
must dis-enrol the person by changing the enrolment status in the PMS to a Registered User or Casual User without
delay.  This will  upload to NES. A note should be made in the daily record stating the reason why the person is no longer
entitled to be enrolled.
  Enrolment Process
Until  such  time  as  the  NES  has  an  interface  for  on-line  enrolment  and  digital  signature,  Contracted  Providers  are
required to ensure enrolling persons (or an authorised representative) complete the Enrolment Process.
The Enrolment Process is completed when a person:
  is provided information about the benefits and implications of enrolment and the services the practice and PHO
provide along with the Contracted Provider and PHO’s name and contact details;
  is provided with information about where personal information is sent and how it is used (refer to Appendix 5
Use of Health Information Requirements);
  is given the opportunity to request a transfer of notes from his/her previous Contracted Provider where a change
in Contracted Provider occurs;
  agrees to provide the required information on the Enrolment Form;
  agrees to the Enrolment Process by (hand) signing and dating the completed Enrolment Form; and
  has the information on the completed Enrolment Form entered into the PMS and uploaded to NES.
Enrolment Form
The Enrolment Form (hard copy and electronic format) must include:
  the enrolment minimum dataset
  the eligibility declaration
  the entitlement declaration
  the My Agreement to the Enrolment Process statements
  the signature of enrolee (or authorised person) and date of signing, noting that the signature must be written
by the hand of the enrolee (or authorised person) using either an ink or electronic pen.
A  sample  Enrolment  Form  (hard  copy)  that  meets  all  the  requirements  of  the  Enrolment  Process  is  included  in
Appendix 4 Sample Enrolment Form.
NB. Although “consent to transfer records” is not a mandatory requirement on the Enrolment form it is required as
part  of  Foundation  Standard  which  is  a  minimum  requirement  within  the  PHO  Services  Agreement.    The  sample
Enrolment Form includes “consent to transfer records” but a separate form may be generated by Contracted Providers
for this purpose.
Enrolment Forms in electronic format must be able to be printed in a format that presents enrolment information in
a format that includes all Enrolment Form requirements.
Enrolment in NES
Contracted  Providers  are  required  to  validate  the  person’s  demographic  details  against  data  held  in  the  NHI.
Contracted Providers should search for and retrieve the person’s NHI details.  A comparison between the person’s NHI
data  and  the  information  provided  by  the  enrolling  person  should  be  made,  and  updates  made  to  NHI  data  as
appropriate following the best practice documentation provided by the Ministry (available on the Ministry website).
http://www.health.govt.nz/our-work/health-identity/national-health-index/nhi-information-health-providers
Authorised  users  should  create  a  new  NHI  record  in  cases  where  a  record  does  not  exist,  using  the  information
provided by the person seeking to enrol.
Page 8 of 34

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When  the  Contracted  Provider  is  satisfied  the  correct  information  for  the  person  has  been  recorded  from  the
Enrolment Form in both the PMS and the NHI they can save the enrolment record to NES, taking note of any warnings
or notifications returned by NES during this process.
A person is considered to be fully enrolled for Capitation Based Funding once their enrolment is accepted by NES.
  Enrolment of Dependants / Individuals lacking capacity
Authorised representatives may enrol dependants.  In the case of a dependent child under 16 years old the Enrolment
Process may be completed by a parent or caregiver who is the legal guardian or who has custody of the child, or the
child themselves if they are competent to do so.
It is recommended that each child is enrolled on his/her own Enrolment Form as ethnicity and next of kin information
may differ from parents (or authorised representatives).
When a dependent child reaches 16 years of age a new Enrolment Form does NOT need to be signed if he/she remains
enrolled with the same Contracted Provider.  The criterion of a consultation with the Contracted Provider within the
previous 3 year period or Confirmation of Enrolment applies (refer Section 7 Enrolment Period).
In the case of other individuals who do not have the capacity to complete and sign an Enrolment Form, the Enrolment
Process can be completed by their legally authorised representative.  Another person who is responsible for the care
and  welfare  of  that  individual  lacking  capacity  can  sign  only  if  the  person  lacking  capacity  does  not  have  a  legally
authorised representative.
  Enrolment Minimum Dataset
A national enrolment minimum dataset is collected on the Enrolment Form.  The required wording is provided, and
mandatory fields indicated, in Appendix 4 Sample Enrolment Form.
The required minimum dataset is:
  NHI
  Full name
  Date of Birth, Place of Birth and Country of Birth
  Gender
  Residential address (which can be recorded as No Fixed Abode in the case of a homeless person)
  Ethnicity
  New or Updated Enrolment Requirements
Changes to Enrolment Requirements do not require Enrolled Persons to sign new Enrolment Forms.  Enrolment Forms
will remain valid if they complied  with the Enrolment Requirements in effect at the time the Enrolment Form was
signed.
Enrolment Forms used from the date a practice begins working with NES must comply with Enrolment Requirements
for Contracted Providers and PHOs V4.1.
Enrolment Requirements V4.1 includes the following new fields in the minimum dataset:
  Place of Birth
It is recommended Contracted Providers collect this additional information from all Enrolled Persons at the next point
of contact.
Enrolment Requirements V4.1 includes a new standardised Use of Health Information Statement. This is provided in
Appendix 5 Use of Health Information Requirements.
Contracted Providers are required to inform Enrolled Persons of any changes to how their health information will be
handled,  if  the  changes  are  such  that  the  Enrolled  Person  did  not  agree  to  them  at  the  time  of  completing  the
Enrolment Process (or Confirmation of Enrolment).
The legal obligation under Rule 3 of the Health Information Privacy Code is for agencies to take 'such steps as are, in
the circumstance, reasonable' to make sure a health consumer (or his/her representative) is aware of:
  The fact that the information is being collected
  The purpose of collection
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  Intended recipients of the information
  The agency or agencies who will be collecting and holding the information (names and addresses)
  Any laws requiring provision of the information
  Any consequences of not providing the information
  Rights of access and correction under the Health Information Privacy Code.
There is no specific requirement to obtain a signed statement from Enrolled Persons as part of Rule 3.
'Reasonable steps' could amount to a practice poster or leaflet.  However, in the event that the Privacy Commissioner
gets a complaint about a Rule 3 breach (e.g. 'I didn't realise my information may be compared with other government
agencies!') it is up to the Contracted Provider to demonstrate their processes of informed consent.
It is recommended that Contracted Providers undertake a risk assessment of the differences between their existing
Use of Health Information Statement and the new standardised Use of Health Information Statement in Enrolment
Requirements V4.0 and make a judgement call as to whether they ask Enrolled Persons to sign the new standardised
Use of Health Information Statement or they notify Enrolled Persons of the changes by way of a practice poster and/or
leaflet.
  Retention of Enrolment Records
Enrolment and dis-enrolment records should be kept so they are readily retrievable for an Audit.  These records may
be kept with the Enrolled Person’s medical records or retained together in separate files for this purpose.
Enrolment  and  dis-enrolment  records  should  be  kept  for  10  years  following  the  last  date  on  which  payment  was
received in respect of the Enrolment.
For further information see Section 10 Dis-enrolment.
  Enrolment Data Collection and Integration with NES
  Data Collection Processes
NES is a web-based solution that integrates with the PMS so that staff of Contracted Providers will not have to go out
of the PMS at any stage to access or upload NES information.
Contracted  Providers  and  PHOs  must  take  all  reasonable  steps  to  ensure  accurate  Enrolled  Person  information  is
entered into their PMS as enrolment information in the PMS uploads to NES.  This also includes changing a person’s
enrolment status in the practice PMS if a person is no longer eligible or entitled to be enrolled.
NES is the ‘single source of truth’ for all national enrolment information.
Enrolled Persons are to be provided with the opportunity to update any of their enrolment, identity and ethnicity
information at any time.
Information held in NES should be in accordance with the agreed data specifications and business rules in the Business
Requirements: National Enrolment Service and Capitation Based Funding Referenced Document:
http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/national-
enrolment-service
  National Health Identity Information
Patient identity information held in the NHI must be updated as soon as new information is provided to a Contracted
Provider by the person. When a person has changed to a new Contracted Provider, the person’s NHI details must be
checked and updated if necessary.
The primary residential addresses of an Enrolled Person must be validated by the eSAM address service before they
are entered in the PMS and saved to NES. The eSam address service uses data from NZ Post, Land Information NZ,
Statistics NZ and the Ministry to provide accurate and standardised address and geospatial data. The Ministry provides
Services  to  Improve  Access  funding  to  health  providers  for  patients  residing  in  areas  coded  by  Statistics  NZ  as  NZ
Deprivation Index 9-10 (corresponding to eSam quintile 5) (in addition to providing Services to Improve Access funding
for patients who identify as being either Māori or Pacific Islander).
If a residential address is not able to be validated by the eSAM address service the following will occur:
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  an Enrolled Person with a non-validated address at the NES Snapshot will receive Capitation Based Funding in
the unknown quintile deprivation payment category.
  an  Enrolled  Person  with  an  address  validated  to  suburb  level  at  the  time  of  the  NES  Snapshot  will  receive
Capitation Based Funding in the quintile deprivation payment category of that suburb.
  Ethnicity Data Collection
Contracted  Providers  and  PHOs  are  required  to  follow  the  collection  process  outlined  in  the  document  entitled
‘Ethnicity Data Protocols for the Health and Disability Sector’ (Ethnicity data protocols).
https://www.health.govt.nz/publication/hiso-100012017-ethnicity-data-protocols
Enrolled Persons must be given the opportunity to self-identify their ethnicity.
The format of the ethnicity question on an Enrolment Form must be presented as it is described in the Ethnicity Data
Protocols.  The reason for having a standardised ethnicity question, format and collection process used by all providers
is to ensure the quality and reliability of ethnicity data and consistency with Census data.
NB.  The NHI will be the data source for a person’s ethnicity and  will provide NES enrolment data at the point a
Contracted  Provider  begins  working  with  NES.    As  Contracted  Providers  confirm  details  with  patients  during
subsequent encounters, ethnicity data in PMS should be used to update NHI ethnicity data.
The required format of the Ethnicity question is set out in Appendix 4 Sample Enrolment Form.
The Ministry provides Services to Improve Access funding for patients who identify as  being either Māori or Pacific
Islander (Level 1 ethnic codes 2 and 3).
PHOs  will  monitor  the  quality  of  the  ethnicity  data  collected  by  Contracted  Providers  and  work  with  Contracted
Providers to correct errors and ethnicity data collection processes.
  NES Notifications
Contracted Providers will receive notification via the NES of any of the following updates to their Enrolled Persons:
  expiry  of  enrolment  (including  enrolment  end  date)  where  there  is  no  record  that  an  Enrolled  Person  has
received a consultation within the previous three years or confirmed their enrolment.
  when a verified date of death for an Enrolled Person is recorded in the NHI.
  where a duplicate enrolment occurs for an Enrolled Person as a result of linking two NHIs. The enrolment with
the  most  recent  Date  of  Enrolment,  Date  of  Confirmation  of  Enrolment  or  Date  of  Last  Consultation  will  be
retained. The other enrolment will be ended.
  when a Contracted Provider enrols a person any previous enrolment for that person will be ended.
  if on the fourth NES Snapshot (or the NES Snapshot next occurring at least 12 weeks after the date of birth of
the newborn, whichever is the sooner) a newborn is still recorded as a B code; the newborn’s enrolment will
expire within NES.
  Preliminary Enrolment Process for Newborns
The  following  process  applies  for  all  newborn  preliminary  enrolments  where  a  Contracted  Provider  accepts  a
notification from the National Immunisation Register  (NIR) as the newborn’s  nominated  on-going provider of First
Level Services.
On acceptance of the NIR notification the Contracted Provider must immediately enter the newborn into the PMS as
a B pre-enrolment code (or as appropriate according to the type of PMS they use).  The pre-enrolment code B stands
for  a  newborn  that  has  been  accepted  for  funding  before  the  Enrolment  Process  has  been  completed.  The  B  pre-
enrolment information in the PMS will upload to NES.
When the Contracted Provider first enters the newborn in the PMS and this is uploaded to NES they should record the
Date of Enrolment as the date the newborn is entered into the PMS, the enrolment status as B, and leave the Date of
Last Consultation blank until the newborn has had a consultation.
If a Contracted Provider accepts the NIR notification, the Contracted Provider should follow best practice by:
  communicating with the family (within a week of accepting the NIR notification) welcoming the newborn to the
practice with the option of  attaching an Enrolment  Form for the newborn if the Eligibility of the newborn is
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already known to the practice.  For example, if at least one of newborn’s parents are eligible the newborn will
also be eligible;
  pre-calling the newborn at four or five weeks of age for a six week immunisation appointment and a general
health and physical assessment; and
  recalling the newborn if she/he did not attend for their six week immunisation and a general health and physical
assessment.
If a completed and signed Enrolment Form is made available to the Contracted Provider in response to the welcome
communication they should:
  change the newborn pre-enrolment code status to Enrolled; and
  update the Enrolment Date in the PMS with the date the Enrolment Form was signed, but leave the Date of Last
Consultation blank until the newborn presents for services.
When  the  newborn  first  presents  for  services  (e.g.  six  week  immunisation)  the  Contracted  Provider  is  required  to
complete the formal Enrolment Process (if the Enrolment Form has not already been completed).  Once the Enrolment
Process is completed the Contracted Provider must change the newborn to Enrolled and update the Enrolment Date
in the PMS to the date the Enrolment Process was completed by the parent or guardian signing an Enrolment Form.
If in the course of completing the Enrolment Process the Contracted Provider finds that the newborn is not  eligible
and/or entitled to enrol, or the parent or guardian declines enrolment, they must change the B pre-enrolment code
to Registered User or Casual User (as appropriate) in their PMS which will upload to NES.
If on the fourth NES Snapshot after the newborn’s date of birth the newborn is still recorded as a B code, the newborn’s
enrolment will expire within NES. All expired enrolments within NES will be excluded for payment purposes.
  Fee Schedule for Newly Enrolled Patients
For Contracted Providers that charge a fee to newly Enrolled Persons:
  a  casual  consultation  fee  may  be  charged  for  the  first  consultation  following  completion  of  the  Enrolment
Process if the Enrolled Person’s first consultation occurs before the last day of the calendar month in which they
complete the Enrolment Process.
  subsequent consultations must be charged at the Enrolled Person consultation rate.
Contracted  Providers  that  charge  newly  Enrolled  Persons  at  the  Enrolled  Person  consultation  rate  for  their  first
consultation are encouraged to continue that practice.
Contracted Providers may claim a General Medical Service (GMS) fee for service subsidy for  eligible persons only in
the calendar month in which the person completes the Enrolment Process, noting that:
  The  number  of  GMS  deductions  against  an  Enrolled  Person’s  CBF  Payment  will  be  ‘capped’  at  three  claims
submitted in a calendar month; and
  GMS deductions will not be made for any newborn for a period of three months from the newborn’s date of
birth.
  Enrolment Period
Three years is the maximum period of time an Enrolled Person residing in New Zealand can remain enrolled with a
Contracted Provider of a PHO without either:
  a First Level Service Consultation being recorded in the Daily Record, and as further described in Section 9; or
  Confirmation of Enrolment occurring through one of the methods detailed in Section 8 below.
A  First  Level  Service  Consultation  or  Confirmation  of  Enrolment  within  a  three  year  period  resets  the  three  year
enrolment period.
If neither of the above is recorded in the PMS then the person’s enrolment will expire in NES at the end of the 3 year
period.
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  Confirmation of Enrolment
An Enrolled Person may confirm their enrolment in three ways:
1.  The  Enrolled  Person  signs  a  confirmation  of  enrolment  form  (NB  The  original  enrolment  form  needs  to  be
retained as either a hard or electronic copy);
2.  The Enrolled Person signs a new Enrolment Form; or
3.  The Enrolled Person confirms continued enrolment through Auditable Contact.
Auditable Contact:
  may be a telephone contact or electronic media exchange with an Enrolled Person that specifically confirms
his/her intention to remain enrolled with the Contracted Provider.
  is only acceptable if the conversation is documented in the Enrolled Person’s Daily Record and there is sufficient
documented evidence that the Enrolled Person’s eligibility and entitlement to be enrolled has been confirmed,
and there is no reason why the Enrolled Person’s eligibility and entitlement to be enrolled would have changed.
  may be used as confirmation of enrolment only if there is a signed Enrolment Form on file. NB Prior to 1 April
2004 a signed Enrolment Form was not required.
  may be used to update the Date of Confirmation of Enrolment field in the PMS if the above conditions are met.
  Date of Last Consultation
The  Date of  Last  Consultation  field  can be updated following a  face-to-face, telephone or other electronic  contact
between an Enrolled Person and a Health Practitioner which is recorded in the person’s patient notes as per the Daily
Record  requirements  of  the  PHO  Services  Agreement  referenced  document  titled  "Daily  record,  laboratory  tests,
diagnostic imaging services, and pharmaceutical requirements".
The following activities should not be used to update the Date of Last Consultation field in the Contracted Provider’s
PMS:
  invoices (for non-clinical related services) and credit notes;
  correspondence, initiated by the Contracted Provider, relating to outstanding debts or other financial matters;
  correspondence, initiated by the Contracted Provider, relating to recalls for immunisation or cervical screening
programmes, for example;
  the receipt of reports from other health service providers, such as radiographs and laboratory test results;
  registration, enrolment or re-enrolment;
  notes about the Enrolled Person’s visits to other providers (e.g. emergency departments); or adding notations
to an Enrolled Person’s clinical records that are not related to an Auditable Contact with the Enrolled Person.

Dis-enrolment
An Enrolled Person is free to dis-enrol at any time.
Where a person has enrolled with a new Contracted Provider, NES will automatically end the previous enrolment and
notify the previous Contracted Provider that the person is no longer enrolled with them. Details of where the person
is enrolled will not be provided in the notification.
If  an  Enrolled  Person  does  not  remain  entitled  to  enrol,  or  is  no  longer  eligible  to  receive  publicly  funded  health
services, the Contracted Provider must change the enrolment status in the PMS  to Registered User or Casual User
without delay as soon as the Contracted Provider becomes aware of an Enrolled Person’s change of entitlement or
eligibility status.
If the Contracted Provider becomes aware that an Enrolled Person either:
  will not be resident in New Zealand for 183 days in the next 12 months; or
  is  currently  not  resident  in  New  Zealand  and  will  not  be  resident  for  183  days  or  greater  in  the  next  12
months;
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the  Contracted  Provider  should change the Enrolled Person’s status in the PMS to Registered User or Casual User
immediately or at the time of departure (whichever is applicable).  The Contracted Provider may re-enrol the person
if and when they re-present, if at that time the person meets the entitlement to enrol and eligibility requirements.
Other sections of these Enrolment Requirements that require dis-enrolment include:
  Section 3.3 (remaining entitled to be enrolled – including receiving long-term continuous and exclusive care
through another funding agreement (eg prison (including remand), NZ Defence Force);
  Section 4.4 (expiry of enrolment, date of death, duplicate or superseding enrolment);
  Section 7 (maximum enrolment period); and
  Section 11.2 (terminating enrolment).
Auditable records must be kept regarding Enrolled Persons (or their families) who advise of emigration, death, or that
they wish to leave a Contracted Provider.
Changing a person's enrolment status in the PMS will upload to NES and change the person’s enrolment status in the
NES.

Declining and Terminating Enrolment

Declining Enrolment
A Contracted  Provider must  not  refuse to  enrol any person because of his/her health  status, anticipated need  for
health services, or any other form of discrimination.
If enrolment has been declined, Contracted Providers and/or PHOs should provide advice to the person on where they
can access urgent health services and use their best endeavours to help the person find another suitable Contracted
Provider.

Terminating Enrolment
The Contracted Provider can only terminate an Enrolled Person’s enrolment if:
  there is genuine concern that the relationship between the  Enrolled Person and  Contracted Provider or the
relevant Health Practitioner is severely compromised; or
  fee-for-service deductions over the preceding six-month period demonstrate that the Contracted Provider is no
longer the Enrolled Person’s regular and on-going Contracted Provider of First Level Services.
An Enrolled Person must be given appropriate notice of any termination of enrolment, the reasons for the termination,
and the opportunity to respond:
  A personal contact such as a documented telephone call contact constitutes appropriate notice;
  Where the Enrolled Person is unable to be contacted by telephone, a letter sent to the last known address is
deemed to constitute appropriate notice.
For Audit purposes relevant information and detail on efforts to contact the  Enrolled Person must be kept and the
final decision with justification recorded in the Daily Record.
If enrolment has been terminated Contracted Providers and/or PHOs should provide advice to the person on where
they  can  access  urgent  health  services  and  use  their  best  endeavours  to  help  the  person  find  another  suitable
Contracted Provider.
If the Contracted Provider receives official notice that the Enrolled Person is deceased, the person’s enrolment should
be immediately terminated in the Contracted Provider’s PMS.

Changes in Contracted Provider and/or PHO

New Contracted Provider
If a person enrols with a new Contracted Provider, the new Contracted Provider must complete the Enrolment Process
(including signing and dating a new Enrolment Form) with the person seeking to enrol, as set out in section 3 of this
document.
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Contracted Provider Changes PHO (including PHO Mergers)
If  a  Contracted  Provider  contracts  with  a  new  PHO  the  Enrolled  Person’s  enrolment  with  the  Contracted  Provider
remains unchanged.  This means no new Enrolment Process is required and the three-year enrolment period with the
Contracted Provider is deemed to continue (i.e. there is no change to either the date of enrolment or date of last
consultation).
The Enrolled Person becomes part of the new PHO’s Enrolled Population and must be informed of the change in PHO
status:
  at the next point-of-contact, or
  by general advertising in the practice rooms, or
  by letter or email, or
  by other forms of general advertising (e.g. local media).

Change of Practice Ownership (including Practice Mergers)
In the event of a change of practice ownership or practice merger and a new Contracted Provider taking on permanent
responsibility for Enrolled Persons, but there is no change in PHO, Enrolled Persons must be informed of the change:
  at the next point-of-contact, or
  by general advertising in the practice rooms, or
  by letter or email, or
  by other forms of general advertising (e.g. local media).
This means no new Enrolment Process is required and the three-year enrolment period with the Contracted Provider
is deemed to continue (i.e. there is no change to either the date of enrolment  or date of last  consultation). If the
change of practice ownership results in a change in PHO, clause 12.2 also applies.

Change of Practice Location
In the event a Contracted Provider changes its practice location, the Enrolled Person’s enrolment with the Contracted
Provider remains unchanged.
The Enrolled Person must be informed of the change:
  at the next point-of-contact, or
  by general advertising in the practice rooms, or
  by letter or email, or
  by other forms of general advertising (e.g. local media).
If the change of practice location results in a change in PHO, clause 12.2 also applies.

Contracted Provider Ceases to Provide Services
If a Contracted Provider ceases providing services (planned or unplanned), its Enrolled Persons will remain part of the
PHO’s  Enrolled  Population  and  the  PHO  is  required  to  make  provision  for  continuing  services  for  the  Contracted
Provider’s Enrolled Persons.

Health Practitioner of a Contracted Provider Moves to a New Contracted
Provider
If a Health Practitioner who is not a Contracted Provider moves to a new Contracted Provider, an Enrolled Person who
was a patient of the Health Practitioner will remain enrolled with the original Contracted Provider unless and until
they choose to enrol with a new Contracted Provider, at which time the new Contracted Provider must complete the
Enrolment Process (including signing and dating a new Enrolment Form) with the enrolling person.

Registered User
A Registered User is a person who:
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  has chosen the Contracted Provider (practice) as their on-going provider of First Level Services; and
o  is not entitled and/or eligible to enrol; or
o  has chosen not to enrol
Registered  Users  have  the  same  continuity  of  care  relationship  with  their  nominated  Contracted  Provider  as  an
Enrolled Person but they are not eligible for capitation based funding and their information is not uploaded to the NES.
A Register User would typically have an “R” (Registered) status within the Contracted Provider’s PMS and be included
in the practice’s population for on-going patient management eg. immunisation and screening programmes.

Casual User
A Casual User is a person who:
  has not chosen the Contracted Provider as their on-going provider of First Level Services; or
  is already enrolled with a Contracted Provider and who visits another Contracted Provider and does not choose
to enrol with that other Contracted Provider (including if both Contracted Providers are part of the same PHO).
Persons who seek health services from another Contracted Provider (including within the same PHO), and do not enrol
are considered a Casual User in terms of funding and access to First Level Services.
Casual Users who are enrolled elsewhere should be encouraged to seek ongoing care from the Contracted Provider
they are enrolled with.
Casual  Users  who  are  not  enrolled  and  are  entitled  and  eligible  to  enrol  should  be  informed  of  the  benefits  of
enrolment and encouraged to enrol with a Contracted Provider of their choice at the earliest opportunity.

Disclosure of Patient Information
Patient information must be managed and disclosed in accordance with the Health Act 1956, Privacy Act 1993, the
Health Information Privacy Code 1994 and the New Zealand Public Health and Disability Act 2000.
Persons must be informed that:
  relevant health information may be  provided to other health professionals  or agencies in the circumstances
described in Appendix 5 Use of Health Information Requirements.
  for payment purposes the Contracted Provider they are enrolled with and the contracting PHO will be informed
of any casual visits to other Contracted Providers if they are:
o  aged under eighteen years
o  have a High Use Health Card
o  have a Community Services Card.
Refer PHO Services Agreement, Schedule C2, Clause; ‘Information about GMS consultations’
NB The Contracted Provider and PHO will be told that a visit took place, the date and time it took place, aggregated
information about  the location at  which the visit took  place, and the type of Health Practitioner who provided the
consultation, but the reasons for the visit will not be disclosed unless authorised by the person.

Disputes
There is a potential for disputes to arise regarding enrolment of people on NES. DHBs and PHOs should have processes
in place for timely resolution of disputes as outlined in dispute resolution clauses of the PHO Services Agreement.

Changes in Enrolment Requirements
Enrolled Persons are not required to sign a new Enrolment Form if there are changes to Enrolment Requirements.
Enrolment Forms are audited against the enrolment requirements in effect at the time of the enrolment.
Updated Enrolment Forms incorporating any new Enrolment Requirements must be used for all new enrolments from
the date the new requirements came in to effect.
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Where new Enrolment Requirements include the collection of new information, this information should be sourced
from the Enrolled Person at the next point of contact and entered into the PMS. If the new information relates to
demographic data that is held in the NHI, the NHI should also be updated.

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Appendix 1 Eligibility Guide
Contracted Providers (along with all other publicly funded health providers) are required to assess the eligibility of the
person to receive publicly-funded health and disability services as per the Eligibility Direction 2011 published in the
Gazette.
Using information from the patient, providers are responsible for taking all reasonable steps to assess the  eligibility
and entitlement of patients to enrol, and entering accurate information into their PMS which  uploads to NES.
Each Contracted Provider or PHO should work out its internal systems and processes and how this will be managed.
Note there is a difference between being eligible for publicly funded health services and being entitled to enrol in a
PHO.  For example, a New Zealand citizen who resides overseas and returns to New Zealand on vacation is eligible for
publicly-funded health services but is not entitled to enrol with a Contracted Provider or PHO as he/she is not living
permanently  in  New  Zealand.    After  completing  the  eligibility  assessment,  it  will  also  be  necessary  to  confirm
entitlement to enrol – see Appendix 4 Sample Enrolment Form for the Entitlement Declaration.
Eligibility Assessment Resources
This  guide  is  designed  to  assist  Contracted  Providers  to  assess  a  person’s  eligibility  for  publicly  funded  health  and
disability services.  The eligibility questions are included in Appendix 4 Sample Enrolment Form.
Eligibility for publicly funded services is determined by the Health and Disability Services Eligibility Direction 2011 (the
Eligibility Direction).  This is a direction made by the Minister of Health under section 32 of the New Zealand Public
Health and Disability Services Act 2000. The direction became effective on 16 April 2011, and applies from that date
forward.
The following resources are recommended to Contracted Providers and PHOs as they clearly sets out how to meet the
Eligibility Direction, and determine those people eligible to enrol  with a Contracted Provider and become part of a
PHO’s Enrolled Population.
  http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services/guide-
eligibility-publicly-funded-health-services-0
  http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services
  http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services/resources-
service-providers-check-eligibility and
  http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services/eligibility-
direction for the legal document that sets out the eligibility criteria.
Process to Assess Eligibility
It is recommended that Contracted Providers have information at reception that reassures people not to be offended
if  they  are  asked  to  provide  evidence  of  citizenship  or  eligibility  for  publicly  funded  health  services.    People  from
overseas would expect to be asked to show proof of eligibility.
Practices may choose to make it a routine practice to ask new patients to bring in documentation at the first visit. If
this is forgotten, documentation could be photocopied and sent by post, or scanned and sent by email.
Contracted Providers may make copies of, and file, documents provided to assess eligibility for publicly funded health
services (eg. Passport) but this information cannot be used for any purpose other than for which it was provided ie. to
assess eligibility.
Contracted Providers are entitled to rely on the documentation provided by the patient unless it patently appears
fraudulent, or is not sufficient to confirm eligibility.
If a person does not already have an NHI number they should be assigned one, regardless of their eligibility status.
Documentation to Assess Eligibility
New Zealand Citizens and Permanent Residents:
If the person’s NZ Citizenship status is Yes, and the NZ Citizenship source code is sent to DIA then practices can be
confident that the person’s citizenship is valid, but may still request hard copy proof if they feel it is appropriate.
Everyone  born  in  New  Zealand  prior  to  2006  was  automatically  a  New  Zealand  citizen,  and  for  the  purposes  of
determining eligibility for publicly funded health services use of a birth certificate prior to 2006 is appropriate.
Page 18 of 34

NB. In order to reduce identity fraud the Department of Internal Affairs is in the process of updating all birth certificates
to have a unique identifier, and any person needing a birth certificate for official purposes may need to purchase a new
one containing this unique identifier.
As  all  New  Zealand  citizens  are  eligible  for  publicly  funded  health  and  disability  services,  expired  New  Zealand
passports can be used for assessment of eligibility provided there are no identity related risks. If a person presents an
expired New Zealand passport you must be confident that the person requesting to be enrolled is who they say they
are. Care should be taken to ensure that the passport is not so old that it is difficult to tell if the person presenting the
passport is the same person on the passport. For example, care would need to be taken if the passport has a picture
of the person as a child.
The following suggestions may help with determining eligibility for publicly funded services.
New Zealanders and New Zealand permanent residents:
  with a Gold Card and receiving Superannuation; or
  on an Unemployment Benefit, Domestic Purposes Benefit, Sickness Benefit or Invalids Benefit
have already proven eligibility for publicly-funded health services by having to provide the required documentation (a
birth certificate or passport) to the Ministry of Social Development or Work and Income NZ.
Being on an emergency benefit does not count towards proof of eligibility.
A NZ driver’s licence can assist with determining identity, but does not have the appropriate information to determine
eligibility.  For  example,  a  person  who  is  not  eligible  for  publicly-funded  health  services  may  have  a  New  Zealand
driver’s licence.  A New Zealand driver’s licence does not provide information on country of birth.
Financial Assistance Available
Beneficiaries and non-beneficiaries are able to apply to Work and Income for financial assistance to meet the cost of
an essential item such as a birth certificate (Advance Payment of Benefit for beneficiaries, and Recoverable Assistance
Payment for non-beneficiaries). There is discretion and consideration of the person’s individual circumstances when
assistance is provided.
The person can phone the Contact Centre on 0800 559 009 to make an appointment. Additional information is also
available on the Work and Income website http://www.workandincome.govt.nz/
Eligibility other than New Zealand Citizen or Permanent Resident:
If a person seeking enrolment is using a non-New Zealand passport for assessment of eligibility for publicly funded
health services, the passport must be valid at the time of enrolment.
Refer to the Eligibility Checklist for each eligibility category and the proof required:
http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-health-services/resources-service-
providers-check-eligibility/eligibility-checklist
NB Those categories of individuals who are eligible for only a ‘limited range of publicly funded health and disability
services’ are not eligible to be enrolled.
Interim  Visa.    If  a  person  has  an  interim  visa  this  means  they  are  waiting  for  Immigration  to  finish  processing  an
application as Immigration issues interim visas if the old visa has run out but the new visa is still being processed.  To
determine the eligibility of an interim visa holder you should look at what their eligibility status was immediately prior
to being issued the interim visa.  For example, the person had a two year work permit and has been issued with an
interim visa while waiting for their application for another two year work permit to be processed.  Immigration usually
issues Interim visas in a letter form.
Eligibility Examples
  Citizen: John was born in New Zealand (before 1 January 2006) and lives permanently in New Zealand.  He is
eligible and entitled to enrol.
o  If his NHI record indicates John’s NZ Citizenship status is Yes, and the NZ Citizenship source code is set
to DIA then no further proof of citizenship is required.
o  If  the  DIA  record  is  not  present  on  the  NHI  data  base  then  a  New  Zealand  passport,  citizenship
certificate or birth certificate must be produced.  If John was born after 1 January 2006 then a birth
certificate alone will not be sufficient to establish eligibility, unless one of the parents on the certificate
establishes their eligibility.
Page 19 of 34

o  If John had been born in the Cook Islands, Niue or Tokelau he would also have New Zealand citizenship.
  Citizen living overseas: Jack was born in New Zealand (before 1 January 2006 – so he is eligible) and moved to
Australia a year ago.  He is back visiting his family for one month.  He is eligible, but not entitled to enrol, as he
is not Residing Permanently in New Zealand.
  Australian citizen or resident intending to stay in New Zealand for at least two consecutive years: Mary was
born in Australia and has been living in New Zealand for a year.  She intends to remain in New Zealand for at
least one more year.  She is eligible and entitled to enrol.  If Mary was only visiting New Zealand for a holiday
she would not be eligible to enrol.
  UK citizen visitor visa: James is six.  He was born in the United Kingdom and is visiting New Zealand for two
months with his parents who are United Kingdom citizens.  He is eligible for emergency medical treatment under
a reciprocal agreement but as he is not fully eligible, he is not eligible to enrol with the general practice.
  Work visa holder legally in New Zealand for two years or more:
o  Susan was born in South Africa and currently has a one year working visa.  Immediately before her visa
started, she was legally in New Zealand on another visa for a year.  Susan is a current work visa holder
who is legally able to stay in New Zealand for a period of at least two consecutive years.  She is eligible
and entitled to enrol.
o  Elizabeth was born in South Africa and has a two-year working visa that will enable her to stay in New
Zealand legally for a  period of two years.  She is eligible and entitled to enrol if she arrived in New
Zealand on a date that leaves a full two-year period until the working visa expires.  If, however, Elizabeth
entered New Zealand part way through the time period on her visa, so that the remaining time left on
her visa was less than a full two-year period, she would not be eligible to enrol as she will be unable to
be legally in New Zealand for two years until she is granted another visa.
o  Jeremy is a Samoan citizen and has just moved to New Zealand.  He holds a one-year work visa.  He will
not be eligible until he gets a work visa for a second year, and so cannot enrol.
  Student visa: Mark is 20, American, and has held student visas for two years.  He is not eligible to enrol.
o  If  Mark  was  a  NZ  Aid  Programme  student  or  a  Commonwealth  Scholar,  from  another  country  and
studying in New Zealand, he would be eligible to enrol
Page 20 of 34

Appendix 2 National Enrolment Minimum Dataset
The  PSAAP  Group  has  developed  a  national  enrolment  minimum  dataset  that  is  required  to  be  included  in  an
Enrolment Form. These mandatory fields are shaded in Appendix 4 Sample Enrolment Form.
  Practice Name (not required to be filled out by the patient, but should be included on the form)
  Patient Consent
  Enrolment Date
  NHI
  Full name
  Date of Birth, Place of Birth and Country of Birth
  Gender
  Residential address (validated by the eSAM service)
  Ethnicity (the ethnicity question must be worded and set out exactly as specified as this is the standard ethnicity
question required by the ‘Ethnicity Data Protocols for the Health and Disability Sector’)

Required for access to other funding:
  High Use Health Card number
Community Services Card number
Non-mandatory information that practices may find useful:
  Consent to the transfer of records from a previous provider
  Other names known by (e.g. maiden name) / Preferred name
  Postal address if different to residential address
  Contact Details (Phone / Cell / Email)
  Emergency contact details
  Occupation
  Private Health Insurance
  Iwi
Page 21 of 34

Appendix 3 Ethnicity Requirements
Contracted  Providers  and  PHOs  are  required  to  follow  the  collection  process  outlined  in  the  document  entitled
‘Ethnicity Data Protocols for the Health and Disability Sector’ available on the Ministry website at the location provided
below.  This  includes  giving  people  the  opportunity  to  self-identify  their  ethnicity  according  to  the  Statistics  New
Zealand Census 2013 ethnicity question. PHOs will monitor the quality of the ethnicity data collected by Contracted
Providers  and  work  with  Contracted  Providers  to  correct  errors  and  ethnicity  data  collection  processes  when
discrepancies in an enrolment register are identified.
https://www.health.govt.nz/publication/hiso-100012017-ethnicity-data-protocols
Page 22 of 34

Appendix 4 Sample Enrolment Form
A sample Enrolment Form has been developed which includes all the mandatory enrolment data requirements as set
out  in  this  document  as  well  as  other  data  fields  commonly  used  in  the  process  of  patient  registration  with  the
Contracted Provider.  Mandatory fields are shaded in the sample Enrolment Form. A black and white version of the
Enrolment Form, with the mandatory fields marked with an asterisk, has also been included for Contracted Providers
that have a need to fax the form.
Other fields have been included that can be customised by Contracted Providers for their own purposes.
Contracted Providers may choose to adapt this sample Enrolment Form however any Enrolment Form  a Contracted
Provider chooses to use must include:
  the enrolment minimum dataset
  an entitlement declaration
  an eligibility declaration
  the My Agreement to the Enrolment Process statements
NB. Although “consent to transfer records” is not a mandatory requirement on the Enrolment form it is required  as
part  of  Foundation  Standard  which  is  a  minimum  requirement  within  the  PHO  Services  Agreement.    The  sample
Enrolment Form includes “consent to transfer records” but a separate form may be generated by Contracted Providers
for this purpose.
The  Contracted  Provider  is  also  required  to  provide  the  enrolling  person  with  information  about  the  benefits  and
implications of enrolment and the services the Contracted Provider and PHO provide along with the PHO’s name and
contact details.

Page 23 of 34

Logo
ENROLMENT FORM
Practice Specific Field eg. Address and Contact Details

Fields shaded in blue are compulsory

Practice Specific Field
NHI (Office use only)

Name

(Title)
Given Name
Other Given Name(s))
Family Name
Other Name(s)

(eg. maiden name)
Please tick the name
you prefer to be
known as

Birth Details

Day / Month / Year of Birth
Place of Birth
Country of birth
Gender





Male FemaleGender diverse (please state)
Occupation

Usual  Residential

Address

House (or RAPID) Number and Street Name
Suburb/Rural Location
Town / City and Postcode
Postal Address

(if different from above)

House Number and Street Name or PO Box Number
Suburb/Rural Delivery
Town / City and Postcode

Contact Details

Mobile Phone
Home Phone
Email Address
Emergency

Contact
Name
Relationship
Mobile (or other) Phone

Transfer of
In order to get the best care possible, I agree to the Practice obtaining my records from my previous Doctor. I also
Records
understand that I will be removed from their practice register, as I am only able to be enrolled at one practice at a
time in New Zealand.
  Yes, please request transfer of my records
  No transfer
  Not applicable

Previous Doctor and/or Practice Name
Address / Location

Ethnicity Details



Which ethnic group(s) do
Community Services Card
New Zealand European
you belong to?
Yes
No
Tick  the  space  or
  Maori

spaces  which  apply

  Samoan
to you

Day / Month / Year of Expiry
Card Number
  Cook Island Maori
Tongan


High User Health Card
Yes
No
Niuean

  Chinese

  Indian
Day / Month / Year of Expiry
Card Number
  Other (such as Dutch,

Japanese, Tokelauan). Please state

Practice Specific Field

Page 24 of 34

My declaration of entitlement and eligibility

I am entitled to enrol because I am residing permanently in New Zealand.

The definition of residing permanently in NZ is that you intend to be resident in New Zealand for at least 183 days in the next 12 months
AND I am eligible to enrol because:
a
I am a New Zealand citizen  (If yes, tick box and proceed to I confirm that, if requested, I can provide proof of my eligibility below)

If you are not a New Zealand citizen please tick which eligibility criteria applies to you (b–j) below:
b
I hold a resident visa or a permanent resident visa (or a residence permit if issued before December 2010)

I am an Australian citizen or Australian permanent resident AND able to show I have been in New Zealand or
c

intend to stay in New Zealand for at least 2 consecutive years
I have a current work visa/permit and can show that I am legally able to be in New Zealand for at least 2 years
d

(previous visas / permits included)
e
I am an interim visa holder who was eligible immediately before my interim visa started

I am a refugee or protected person OR in the process of applying for, or appealing refugee or protection
f

status, OR a victim or suspected victim of people trafficking
I am under 18 years and in the care and control of a parent/legal guardian/adopting parent who meets one
g

criterion in clauses a–f above OR in the control of the Chief Executive of the Ministry of Social Development
I am a NZ Aid Programme student studying in NZ and receiving Official Development Assistance funding (or
h

their partner or child under 18 years old)
i
I am participating in the Ministry of Education Foreign Language Teaching Assistantship scheme

I am a Commonwealth Scholarship holder studying in NZ and receiving funding from a New Zealand university
j

under the Commonwealth Scholarship and Fellowship Fund

I confirm that, if requested, I can provide proof of my eligibility
 Evidence sighted (Office use only)

My agreement to the enrolment process
NB. Parent or Caregiver to sign if you are under 16 years
I intend to use this practice as my regular and ongoing provider of general practice / GP / health care services.
I understand that by enrolling with this practice I will be included in the enrolled population of this practice’s Primary Health
Organisation (PHO) [PHO name…..], and my name address and other identification details will be included on the Practice,
PHO and National Enrolment Service Registers.
I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.
I  have  been  given  information  about  the  benefits  and  implications  of  enrolment  and  the  services  this  practice  and  PHO
provides along with the PHO’s name and contact details.
I have read and I understand the Use of Health Information Statement.  The information I have provided on the Enrolment
Form  will  be  used  to  determine  eligibility  to  receive  publicly-funded  services.  Information  may  be  compared  with  other
government agencies, but only when permitted under the Privacy Act.
I understand that the Practice participates in a national survey about people’s health care experience and how their overall
care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the
survey by informing the Practice. The survey provides important information that is used to improve health services.
I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.
Signatory Details



Signature
Day / Month / Year
Self Signing
Authority
An authority has the legal right to sign for another person if for some reason they are unable to consent on their own behalf.
Authority Details

(where signatory is not
Full Name
Relationship
Contact Phone
the enrolling person)

Legal basis of authority (e.g. parent of a child under 16 years of age)
Page 25 of 34

Practice Logo
Practice Specific Field eg. Address and Contact Details

ENROLMENT FORM

Fields with * are compulsory
Anyone over age of 16 years must complete their own enrolment form
NHI  (Office use only)

Name
Title
* Given Name
* Other Given Name(s)
* Family Name
Other Name(s)

(eg. maiden name)
Please tick the name
you prefer to be
known as

Birth Details
* Day / Month / Year of Birth
* Place of Birth
* Country of birth
Gender
*


Male
Female
Gender Diverse (please state)
Occupation

Usual Residential
Address
* House (or RAPID) Number and Street Name
* Suburb/Rural Location
* Town / City and Postcode

Postal Address

(if different from above)

House Number and Street Name or PO Box Number
Suburb/Rural Delivery
Town / City and Postcode

Contact Details
Mobile Phone
Home Phone
Email Address
Emergency

Contact
Name
Relationship
Mobile (or other) Phone

In order to get the best care possible, I agree to the Practice obtaining my records from my previous Doctor. I also
understand that I will be removed from their practice register.
Transfer of
  Yes, please request transfer of my records
  No transfer
  Not applicable
Records

Previous Doctor and/or Practice Name
Address / Location

Ethnicity Details
*
Community Services Card
Yes  No
Which ethnic group(s) do
you belong to?

New Zealand European

Tick  the  space  or

Maori
spaces  which  apply

to you

Samoan
Day / Month / Year of Expiry
Card Number

Cook Island Maori
High User Health Card
Yes  No


Tongan

Niuean

Day / Month / Year of Expiry
Card Number

Chinese

Indian

Other (such as Dutch,
Japanese, Tokelauan). Please state

Practice Specific Field

Page 26 of 34

*                 My declaration of entitlement and eligibility                  *

I am entitled to enrol because I am residing permanently in New Zealand.

The definition of residing permanently in NZ is that you intend to be resident in New Zealand for at least 183 days in the next 12 months
I am eligible to enrol because:
a
I am a New Zealand citizen  (If yes, tick box and proceed to I confirm that, if requested, I can provide proof of my eligibility below)

If you are not a New Zealand citizen please tick which eligibility criteria applies to you (b–j) below:
b
I hold a resident visa or a permanent resident visa (or a residence permit if issued before December 2010)

c
I am an Australian citizen or Australian permanent resident AND able to show I have been in New Zealand or

intend to stay in New Zealand for at least 2 consecutive years
d
I have a work visa/permit and can show that I am able to be in New Zealand for at least 2 years (previous

permits included)
e
I am an interim visa holder who was eligible immediately before my interim visa started

f
I am a refugee or protected person OR in the process of applying for, or appealing refugee or protection

status, OR a victim or suspected victim of people trafficking
g
I am under 18 years and in the care and control of a parent/legal guardian/adopting parent who meets one

criterion in clauses a–f above OR in the control of the Chief Executive of the Ministry of Social Development
h
I am a NZ Aid Programme student studying in NZ and receiving Official Development Assistance funding (or

their partner or child under 18 years old)
i
I am participating in the Ministry of Education Foreign Language Teaching Assistantship scheme

j
I am a Commonwealth Scholarship holder studying in NZ and receiving funding from a New Zealand university

under the Commonwealth Scholarship and Fellowship Fund

I confirm that, if requested, I can provide proof of my eligibility
 Evidence sighted (Office use only)

My agreement to the enrolment process
NB. Parent or Caregiver to sign if you are under 16 years
I intend to use this practice as my regular and ongoing provider of general practice / GP / health care services.
I understand that by enrolling with this practice I will be included in the enrolled population of this practice’s Primary Health
Organisation (PHO) [PHO name…..], and my name address and other identification details will be included on the Practice,
PHO and National Enrolment Service Registers.
I understand that if I visit another health care provider where I am not enrolled I may be charged a higher fee.
I  have  been  given  information  about  the  benefits  and  implications  of  enrolment  and  the  services  this  practice  and  PHO
provides along with the PHO’s name and contact details.
I have read and I understand the Use of Health Information Statement. The information I have provided on the Enrolment
Form  will  be  used  to  determine  eligibility  to  receive  publicly-funded  services.  Information  may  be  compared  with  other
government agencies, but only when permitted under the Privacy Act.
I understand that the Practice participates in a national survey about people’s health care experience and how their overall
care is managed. Taking part is voluntary and all responses will be anonymous. I can decline the survey or opt out of the
survey by informing the Practice. The survey provides important information that is used to improve health services.
I agree to inform the practice of any changes in my contact details and entitlement and/or eligibility to be enrolled.
Signatory Details
*
*



  Signature
   Day / Month / Year
Self Signing
Authority
An authority has the legal right to sign for another person if for some reason they are unable to consent on their own behalf.

Authority Details(where
Full Name
Relationship
Contact Phone
signatory is not the enrolling

person)
Basis of authority (e.g. parent of a child under 16 years of age)

Page 27 of 34

Appendix 5 Use of Health Information Requirements
The legal obligation under Rule 3 of the Health Information Privacy Code is for agencies to take 'such steps as are, in
the circumstances, reasonable' to make sure a health consumer (or his/her representative) is aware of:
  The fact that the information is being collected
  The purpose of collection
  Intended recipients of the information
  The agency or agencies who will be collecting and holding the information (names and addresses)
  Any laws requiring provision of the information
  Any consequences of not providing the information
  Rights of access and correction under the Health Information Privacy Code.
There is no specific requirement to obtain a signed statement from health consumers as part of Rule 3 of the Health
Information Privacy Code, however it is recommended that as part of the Enrolment Process the elements of the Use
of Health Information Statement are:
  provided to the enrolling person in written or practice poster form; and
  the enrolling person indicates on the Enrolment Form that they have read and understood the Use of Health
Information Statement.
The Use of Health Information Statement has been developed by the Health Information Governance Expert Advisory
Group (HIGEAG) at the request of PSAAP.  HIGEAG is a group of subject matter experts from around the sector who
were brought together to draft the Health Information Governance Framework. The Statement was developed with
input from the National Health IT Board Consumer Panel and a number of independent consumer groups.
The Use of Health Information Statement is provided below.
Use and confidentiality of your health information (fact sheet)
Your privacy and confidentiality will be fully respected. This fact sheet sets out why we collect your information and
how that information will be used.
Purpose
We collect your health information to provide a record of care. This helps you receive quality treatment and care when
you need it.
We also collect your health information to help:
  keep you and others safe
  plan and fund health services
  carry out authorised research
  train healthcare professionals
  prepare and publish statistics
  improve government services.
Confidentiality and information sharing
Your privacy and the confidentiality of your information is really important to us.
  Your health practitioner will record relevant information from your consultation in your notes.
  Your health information will be shared with others involved in your healthcare, and with other agencies with
your consent, or if authorised by law.
  You don’t have to share your health information, however, withholding it may affect the quality of care you
receive. Talk to your health practitioner if you have any concerns.
Page 28 of 34

  You have the right to know where your information is kept, who has access rights, and, if the system has audit
log capability, who has viewed or updated your information.
  Your information will be kept securely to prevent unauthorised access.
Information quality
We’re required to keep your information accurate, up-to-date and relevant for your treatment and care.
Right to access and correct
You have the right to access and correct your health information.
  You have the right to see and request a copy of your health information. You don’t have to explain why you’re
requesting that information, but may be required to provide proof of your identity. If you request a second copy
of that information within 12 months, you may have to pay an administration fee.
  You can ask for health information about you to be corrected. Practice staff should provide you with reasonable
assistance. If your healthcare provider chooses not to change that information, you can have this noted on your
file.
Many practices now offer a patient portal, which allows you to view some of your practice health records online. Ask
your practice if they’re offering a portal so you can register.
Use of your health information
Below are some examples of how your health information is used.
  If your practice is contracted to a Primary Health Organisation (PHO), the PHO may use your information for
clinical and administrative purposes including obtaining subsidised funding for you.
  Your  District  Health  Board  (DHB)  uses  your  information  to  provide  treatment  and  care,  and  to  improve  the
quality of its services.
  A clinical audit may be conducted by a qualified health practitioner to review the quality of services provided to
you. They may also view health records if the audit involves checking on health matters.
  When you choose to register in a health programme (eg immunisation or breast screening), relevant information
may be shared with other health agencies involved in providing that health programme.
  The Ministry of Health uses your demographic information to assign a unique number to you on the National
Health Index (NHI). This NHI number will help identify you when you use health services.
  The Ministry of Health uses health information to measure how well health services are delivered and to plan
and fund future health services. Auditors may occasionally conduct financial audits of your health practitioner.
The auditors may review your records and may contact you to check that you received those services.
  Notification of births and deaths to the Births, Deaths and Marriages register may be performed electronically
to streamline a person’s interactions with government.
Research
Your health information may be used in research approved by an ethics committee or when it has had identifying
details removed.
  Research which may directly or indirectly identify you can only be published if the researcher has previously
obtained your consent and the study has received ethics approval.
  Under the law, you are not required to give consent to the use of your health information if it’s for unpublished
research or statistical purposes, or if it’s published in a way that doesn’t identify you.
Complaints
It’s OK to complain if you’re not happy with the way your health information is collected or used.
Talk to your healthcare provider in the first instance.  If you are still unhappy with the response you can call the Office
of the Privacy Commissioner toll-free on 0800 803 909, as they can investigate this further.
For further information
Visit www.legislation.govt.nz to access the Health Act 1956, Official Information Act 1982 and Privacy Act 1993.
Page 29 of 34

The Health Information Privacy Code 1994 is available at www.privacy.org.nz. You can also use the Privacy
Commissioner’s Ask Us tool for privacy queries.
A copy of the Health and Disability Committee’s Standard Operating procedures can be found at
http://ethics.health.govt.nz/operating-procedures
Further detail in regard to the matters discussed in this Fact Sheet can be found on the Ministry of Health website at
http://www.health.govt.nz/your-health/services-and-support/health-care-services/sharing-your-health-information

Page 30 of 34

Appendix 6 Enrolment Appeal Form
An enrolling person has 30 days from the date when they were declined enrolment to appeal the decision to decline
to enrol. If the enrolling person(s) a couple or a family that has been declined enrolment this form should be completed
for each individual.
Email the completed form to:
[email address]
The Enrolment Appeal Office will respond to you within 20 working days of receiving your appeal.

Page 31 of 34

PHO ENROLMENT APPEAL FORM
Email completed form to: [email address] or post to Central TAS, PO Box 23075, Wellington 6140
Legal

Name
(Title)
Given Name
Other Given Name(s))
Family Name
Birth Details

Day / Month / Year of Birth
Country of Birth
NHI Number  (Practice to supply)
Usual  Residential

Address
House (or RAPID) Number and Street Name
Suburb/Rural Location
Town / City and Postcode
Contact Details

Mobile Phone
Home Phone
Email Address
Practice Details

Practice Name
Practice Phone Number
Day / Month / Year when enrolment was declined
I am entitled to enrol because:
I intend to use this practice as my regular and ongoing provider of general practice services

I am residing permanently in New Zealand.

The definition of residing permanently in NZ is that you intend to be resident in New Zealand for at least 183 days in the next 12 months
I am eligible to enrol because:
a
I am a New Zealand citizen

If you are not a New Zealand citizen please tick which eligibility criteria applies to you (b–j) below:
b
I hold a resident visa or a permanent resident visa (or a residence permit if issued before December 2010)

c
I am an Australian citizen or Australian permanent resident AND able to show I have been in New Zealand or

intend to stay in New Zealand for at least 2 consecutive years
d
I have a work visa/permit and can show that I am able to be in New Zealand for at least 2 years (previous

permits included)
e
I am an interim visa holder who was eligible immediately before my interim visa started

f
I am a refugee or protected person OR in the process of applying for, or appealing refugee or protection

status, OR a victim or suspected victim of people trafficking
g
I am under 18 years and in the care and control of a parent/legal guardian/adopting parent who meets one

criterion in clauses a–f above OR in the control of the Chief Executive of the Ministry of Social Development
h
I am a NZ Aid Programme student studying in NZ and receiving Official Development Assistance funding (or

their partner or child under 18 years old)
i
I am participating in the Ministry of Education Foreign Language Teaching Assistantship scheme

j
I am a Commonwealth Scholarship holder studying in NZ and receiving funding from a New Zealand university

under the Commonwealth Scholarship and Fellowship Fund

Attach proof of your eligibility.  Copies of birth certificates, passports, visas etc are acceptable.

Please state on what criteria where you were declined enrolment with this practice

Please explain why you believe you should be permitted to enrol with this practice

Signatory Details

Signature
Day / Month / Year
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Glossary of Terms
Audit includes an inspection, monitoring,  audit, investigation, review and evaluation of the PHO’s or a  Contracted
Provider’s performance and compliance with the terms of the PHO Services Agreement, in accordance with Part B of
that Agreement.
Contracted Provider (of First Level Services) means any health service provider whether an organisation,practice or
individual that the PHO subcontracts to deliver First Level Services and other services as described in the PHO Services
Agreement Part H, and includes the Contracted employees, agents and subcontractors.
Demographic Information includes name, address, date and place of birth and ethnicity.  Demographic information is
recorded against a National Health Index (NHI) number.  For more information about the National Health Index and
your National Health Index number, see http://www.health.govt.nz/our-work/health-identity/national-health-index.
Eligibility is described in the Eligibility Direction 2011, and means the right to be considered to receive publicly funded
services.  It is not an entitlement to receive any particular services (refer to the definition of Entitlement).
Enrolment see Enrolment Process
Enrolled Person is someone who has completed the Enrolment Process
Enrolment Process describes the process a person has undertaken to be become an Enrolled Person with a Contracted
Provider and part of a PHO’s Enrolled Population.  The Enrolment Process includes:
  confirming the identity of the person;

  assessing  the  person’s  eligibility  to  receive  publicly-funded  health  and  disability  services  and  entitlement  to
enrol;
  the person completing and signing an Enrolment Form (with associated requirements);
  being informed of the PHO the Contracted Provider is contracted to and the services available through the PHO;
and
  having their enrolment information uploaded to the National Enrolment Service (NES).
Entitlement means the person is entitled to enrol with a Contracted Provider of a PHO if he/she:
  intends to use the practice as his/her regular and ongoing provider of First Level Services; and
  intends to reside permanently in New Zealand (resident in NZ for more than 183 days in the next 12 months);
and
  is  not  receiving  his/her  long-term  continuous  and  exclusive  care  through  another  funding  Agreement  eg.
Department of Corrections (prison and remand), NZ Defence Force.
First Level Services as defined in the PHO Services Agreement Part H are the provision of a full range of primary health
care services to the enrolled population that aim to improve, maintain and restore health and ensure access to care
for the enrolled population.  Care is coordinated with other health and social service agencies, as appropriate.  First
Level Services can also be provided to Casual Users.  First Level Services are ideally provided by teams including General
Practitioners, Nurse Practitioners, Registered Nurses and a range of other health professionals who have appropriate
training and/or qualifications.
First  Level  Service  Consultation  is  the  provision  of  clinical  health  services  defined  in  Part  H  of  the  PHO  Services
Agreement to an Enrolled Person by a member of a General Practice Team.
Health Identifiers are required to submit a person’s enrolment with a Contracted Provider to the National Enrolment
Service and include the following:
  National Health Index (NHI) number
  Health  Provider  Index  Organisation  Number  (HPI-O).  A  HPI-O  number  has  been  assigned  for  each  General
Practice and Primary Health Organisation
  Health  Provider  Index  Person  Number  (HPI-P).  Also  referred  to  as  HPI-CPN  Common  Person  number.  These
numbers have been assigned to all Practitioners since 2004.  The Medical Council provides details to the HPI for
all Medical Practitioners number.
National  Enrolment  Service  (NES)  is  the  enrolment  service  hosted  by  the  Ministry  that  is  the  master  information
source for a person’s enrolment status.  It has links to other core services, and is used to maintain the central database
Page 33 of 34

of enrolments of patients who are eligible for and entitled to funded healthcare, and to maintain patient demographic
information in the NHI. Also referred to as the ‘single source of truth’ (for primary care enrolment data).
Patient Identity Services are available to Contracted Providers through their Practice Management System (see below)
and link directly to the National Health Index, allowing the most up to date patient identity data to be synchronised
between the PMS and the central NHI database.
Practice Management System (PMS) refers to the software application used by the Contracted Provider to manage its
clinical and financial operation.
Primary Health Organisation (PHO) is a not-for-profit community-based organisation contracted to, and funded by,
district health boards to support the provision of essential primary health care services through general practices to
those  people  who  are  enrolled  with  Contracted  Providers  of  the  PHO.    For  more  information  see
http://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations
Residing Permanently in New Zealand means a person will be deemed as residing permanently in New Zealand if
she/he confirms that she/he intends to be resident in New Zealand for at least 183 days in the next 12 months. (NB
resident in NZ for at least 183 does not mean that a person cannot travel casually within this period.)
‘single source of truth’ is a reference to NES as the central repository for primary care provider enrolment data and
the associated funding entitlement for patients, and acknowledging that it derives from the NHI as the central source
of health identity data.

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Document Outline