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Thank you for enrolling in the Get Psorted Get Connected peer support program
A nurse from Aesir Health will be in contact with you shortly to discuss enrolment into the program.
During this conversation, to determine if the Get Psorted Get Connected peer support program is right for you, the nurse will discuss your background, your reasons for getting involved and to complete a short questionnaire.
If you have any questions regarding enrolment or other aspects of the Get Psorted Get Connected program, call 1800 669 776.
Terms and Conditions
1. The Program is sponsored by Janssen-Cilag Pty Ltd ("Janssen") for patients who have been diagnosed with Psoriasis ("You").
2. The Program is managed and administered by Aesir Health Pty Ltd (the "Program Manager") and all communications
with You regarding administration of the Program will be through a registered nurse provided by the Program Manager
(the "Support Nurse").
3. You hereby consent to the Support Nurse:
contacting You to introduce you to the Program, obtain a brief medical history and information about Your journey with Psoriasis and Your reasons for wanting to engage with the Program ("Your Story"), and to otherwise administer the Program;
communicating with Your nominated doctor, to confirm or obtain information regarding Your condition to assist in providing the Program and to provide them with information regarding Your enrolment, Your receipt of Program services and Your progress in the Program;
providing general information regarding Your Story to a peer supporter engaged by the Program Manager ("Peer Supporter"), for the purpose of that Peer Supporter telephoning You (at a convenient time) to provide non-medical support and information and to share their own Psoriasis journey with You.
4. You consent to the Peer Supporter calling You on the phone number provided by You in this form, for the purposes of discussing Your Story with you and sharing their own Psoriasis journey as well as providing general peer support and information regarding further resources you can access, (each call from a Peer Supporter is a "Support Call").
5. You acknowledge and agree that:
it is intended that each Support Call is a maximum of 30 minutes in duration;
the Peer Supporter may end the Support Call at any time, at their sole discretion;
subject to clause 11 below, You may receive up to a maximum of 4 Support Calls at Janssen's discretion.
6. Information received from the Program Manager, Support Nurse and Peer Supporter must not be relied on as medical advice. If you have any concerns about your medication, disease or general health, you should always contact your doctor.
7. As set out in clause 3 above, your doctor will be informed of your enrolment and participation in the Program and if Your doctor has concerns, the Program Manager may not be able to offer the Program services to You. The Support Nurse will discuss with you what other support may be available.
8. You acknowledge and agree that the Program Manager (including the Support Nurse) is legally obliged to pass on details of any adverse events that it becomes aware of, to Janssen. You understand that Janssen or an authorised third party may contact Your doctor for the purpose of an adverse event follow up.
9. The Program is funded by Janssen, and neither Your doctor nor any healthcare professional engaged in the management of Your health is provided with payment of any kind for using the Program or suggesting that You enrol in the Program;
10. Subject to clause 11, the Program will be available until 31 October 2018 unless extended by Janssen, at its sole discretion.
11. Janssen reserves the right to cease funding the Program (or any part of the Program) and to terminate or vary the Program at any time. The Program Manager will seek to contact You to notify You of the cessation of the Program.
12. You may opt out of this Program at any time by calling 1800 669 776, emailing [email protected] or writing to Janssen Get Psorted Get Connected, PO Box 202, Hampton VIC 3188. No stamp is required. If You have any questions, complaints or claims in relation to the Program You should contact Aesir Health on 1800 669 776.
Patient Privacy Statement
I understand by accepting the Terms and Conditions I am acknowledging that:
Janssen, sponsor of the Program, has engaged Aesir to manage and deliver the Program;
I am registering for the Program for people who have a diagnosis of psoriasis; and
In order to register for this Program I need to provide Aesir with my personal information (which includes information regarding my health and medical history).
I consent to my personal information being collected and used by Aesir (and any contracted service provider in its place) for the purpose of arranging and managing the Program and to provide me with services and resources relating to my condition and ongoing health needs.
I understand that unless I ask Janssen or Aesir not to, Aesir may contact me to obtain feedback on my experience of the Program. Aesir will provide certain de-identified aggregate data to Janssen in respect of patient feedback and the Program for the purposes of analysing trends, drive Program improvement, conducting research and publication of such findings at health care professional educational symposium. I understand that any such publication will not identify me individually.
If you would like to know more about Janssen's or Aesir's privacy policies, or if you would like to access or update your personal information, please contact Aesir on 1800 669 776.
This Program is not an emergency service. In case of emergency, please contact your doctor.
The Get Psorted Get Connected peer support program Is sponsored by Janssen-Cilag Pty Ltd, ABN 47 000 129 975, 1-5 Khartoum Road, Macquarie Park NSW 2113 Australia. Ph: 1800 226 334 Date of preparation: July 2018 JANS2338/EMBC CP-62467
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