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Pre placement RDNS requirements include:

A completed and signed Confidentiality Statement (Pg 2 of this document)

A completed and signed Student Contact Form (Pg 3 of this document)

A certified National Police check. If you have a fit2work National Police

History Check Report you can email a copy of this which does not need to be

A certified copy of your WWC card (face up). We also need a copy of your WWC
status, stating you are a volunteer. This can be found here: Simply print off a screen
shot with your details.

All completed, certified and signed documents must be sent through to We expect these documents 2 weeks prior to your
placement. If we havent received your documents as detailed above your placement
can be cancelled. We did cancel placements last year due to students failing to follow
these pre placement instructions.

Once these documents have been received we will confirm your placement, and
advise the RDNS site so they can contact you to arrange an appropriate meeting
place and time.

Please be mindful that our nurses work remotely and do not have a printer. Any
paper attendance records or assessments will need to be printed by yourself prior to
your placement. The nurses all have a laptops so electronic assessments will not be
an issue.

You need to read the Clinical Placement Student Handbook before your placement

Wishing you all the best for your community placement!

Annexure B : Confidentiality Statement

All students undertaking a clinical placement at RDNS are required to read and acknowledge the
1. You must only use personal and health information of RDNS clients for the legitimate purpose of
your placement.

2. You must take all reasonable measures to ensure that you treat as confidential any personal
information, health information and confidential information disclosed to you during your
placement. This obligation exists both during and after your placement.

3. You must at all times comply with the Privacy Act 1988 (Cth) and Health Records Act 2001 (Vic)
and all other relevant legislation relating to the privacy of information.

4. You must be familiar with and at all times fully comply with all relevant RDNS policies and
procedures including those related to the privacy and/or confidentiality of information.

5. You must return to RDNS before the end of your placement all documents in your custody which
contain any personal information, health information or confidential information.

6. Definitions:
6.1 Confidential information means information which is not in the public domain and
which may reasonably be considered as confidential to and by RDNS including, but not
limited to, business information relating to RDNS, information regarding intellectual
property owned by RDNS and information commercially sensitive to RDNS. For the
purposes of this definition, all references to RDNS include its related entities and alliance

6.2 Personal information means information or an opinion (including information or an

opinion forming part of a database), whether true or not, and whether recorded in material
form or not, about a natural person whose identity is apparent, or can reasonably be
ascertained, from the information or opinion, and includes health information.
6.3 Health information includes information or an opinion about:

(a) The physical, mental or psychological health of an individual;

(b) The disability of any individual;
(c) An individuals expressed wishes about the future provision of health services to
him or her; and
(d) A health service provided or to be provided to an individual.

I have read and understood the above requirements.


Name (please print)

Annexure A : Student Contact Form

This form is to be completed in full and sent to RDNS 1-2 weeks prior to your placement.
We are collecting your personal information for the purposes of running the clinical placement program
and to ensure your adequate supervision. This information will only be used by RDNS during or after
your placement, in the case of an emergency, or if there is a legitimate reason to subsequently follow up
on any aspect of your placement. If you do not wish to provide your personal information, you cannot
participate in the program. We will not provide your personal information to any third party. Our
Information Privacy Policy Statement details how your personal information is collected, stored and
managed at RDNS; how you may access and correct that information; how you may complain about a
suspected breach of your privacy by RDNS and how RDNS will respond. For a copy of the statement
you may phone us on 1300 33 44 55 or visit

PLEASE PRINT (use black or dark blue pen only)

Full name:
_____________________________________________________ Postcode: _______________________________
Phone: Home: _____________________________________ Mobile: __________________________________
Date of Birth: _________________ Email:

How are you travelling to your clinical placement? Own Transport / Public Transport

_______________________________________________________ Postcode: ____________________________
Phone: Home: _______________________________________ Mobile: ________________________________

Name of Institution:
Course being studied:
Year/Level: _________________ Student ID: ________________________________
Dates of placement: ________________to __________________________________
I certify that the information given in this form is true and correct and I agree to its use by RDNS as
detailed above.

Signed: _______________________________________________ Date: