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MC-FRM-NUR-002 · High Intensity Nursing Supports Consent (Module 1)

Mayim Group Pty Ltd trading as Mayim Care
This form records informed consent for high intensity daily personal activities (NDIS Practice Standards, Module 1) delivered by Mayim Care. Select the supports Mayim Care will be providing and a consent section will appear for each one. Consent is given separately for each support, and you can say yes to some and no to others.
Your rights. Consent is voluntary. You can withdraw or change it at any time by telling any Mayim Care worker, and this will not affect your other supports. Each support is delivered only by workers who have been trained and assessed as competent for that support, in line with a plan prepared by a suitably qualified health practitioner.

1. Participant and consenting party

Participant full name

Participant date of birth

NDIS number

Who is giving consent?

A
B

2. Supports being provided

Which high intensity nursing supports will Mayim Care be providing?