Chapel St, Prahran VIC 3181, Australia
0411-209-085
info@eazyplanmanagement.com.au
I consent to my information being provided to Melcare Family Service for the purposes of referral, service delivery and inclusion in de-identified data reporting.
I acknowledge receipt of information from Melcare Family Service about the following:– Scope of service delivery and the role and responsibilities of the Plan Manager– Preferred method of invoicing and/or how receipts for reimbursement are exchanged– Plan Management fee including initial setup costs and monthly fee for ongoing financial administration.– The process of dispute resolution, providing feedback or making a complaint– I agree to the terms and conditions of the agreement and understand the contract.– I understand, for me to receive the best possible service, relevant information about me may be forwarded to the agency(s) listed, that may also provide these services: 1- Allied Health Services 2- NDIS 3- Service Providers
Changes to this Service AgreementIf changes to the supports or their delivery are required, the Parties agree to discuss and review this Service Agreement. The Parties agree that any changes to this Service Agreement will be in writing, signed, and dated by the Parties.Ending this Service AgreementShould either Party wishes to end this Service Agreement they must give 28 days’ notice or as mutually agreed between both parties. If either Party seriously breaches this Service Agreement the requirement of notice will be waived.Feedback, Complaints, and DisputesIf the Participant wishes to provide feedback, the Participant can talk to Abdallah Gemaa Idris Elamin on 0411 209 085.If the Participant is not happy with the provision of supports and wishes to make a complaint, theParticipant can talk to Abdallah Gemaa Idris Elamin on 0411 209 085, or in person by visiting our office Monday to Friday, 09:00 am – 05:00 pm at 11 Prime Street, MICKLEHAM, VIC 3064.If the Participant is not satisfied or does not want to talk to this person, the Participant can contact the National Disability Insurance Scheme by calling 1800 800 110, visiting one of their offices in person, or visiting ndis.gov.au for further information.Participant ConsentMelcare Family Service will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:• We are obliged by law to disclose your information regardless of consent or otherwise• It is unreasonable or impracticable to gain consent or consent has been refused; and• The disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.
Name: Abid Hussain
Organization: Melcare Family Services
Address: 11 PRIME ST, MICKLHAM VIC 3064
Contact (Mobile): 0410969786
Email Address: admin@eazyplanmanagement.com.au
Plan Manager Signature:
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