CHCPRT001 AT02-SA01 Risk of Harm Fax Report WRD PRT.docx

Did this incident result in a physical injury to a

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Did this incident result in a physical injury to a Child/Young v Yes No If yes, please provide details: The confidentiality of information contained within this facsimile transmission may be protected by statute. Unauthorised disclosure or misuse of such confidential information obtained as a result of mistaken transmission may incur a liability for criminal penalty. Information contained within this facsimile transmission is intended only for use of Community Services. Any other recipient is requested to immediately notify the sender by telephone so that arrangements can be made for return of the transmission to the sender. 5
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Person? Did this incident result in a physical injury to another person? v Yes No If yes, please provide details: Did this incident result in medical attention/treatme nt? V Yes No If yes, please provide details: What is the nature of your ongoing professional role, if any, with the child/ren, young person/s and their parents/carers, and the frequency, duration and type (if applicable)? What other services or supports are currently in place to support the child/ren, young person/s and their parents/carers (if known)? Is the family, child or young person aware that this report has been made? Yes v No Do you consent for your identifying information to be provided to JIRT (NSW Police and NSW Health) or NSW Police (LAC) and/or NSW Health in the event that JIRT does not accept the report for action? v Yes No If the report is referred to NSW Police, the same protections and confidentiality relating to your identity will continue to apply as per Section 29 of the Children and Young Persons (Care and Protection) Act 1998 . Reporter’s name (please print clearly) HeeYeon KWON Signature H.Y.K Date and time 06/05/2015 The confidentiality of information contained within this facsimile transmission may be protected by statute. Unauthorised disclosure or misuse of such confidential information obtained as a result of mistaken transmission may incur a liability for criminal penalty. Information contained within this facsimile transmission is intended only for use of Community Services. Any other recipient is requested to immediately notify the sender by telephone so that arrangements can be made for return of the transmission to the sender. 6
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The confidentiality of information contained within this facsimile transmission may be protected by statute. Unauthorised disclosure or misuse of such confidential information obtained as a result of mistaken transmission may incur a liability for criminal penalty. Information contained within this facsimile transmission is intended only for use of Community Services. Any other recipient is requested to immediately notify the sender by telephone so that arrangements can be made for return of the transmission to the sender. 7
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  • Three '16
  • unknown
  • Confidentiality, Secrecy, Fax

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