FREEDOM OF INFORMATION
REQUEST FORM
Under the
Freedom of Information Act 1982 (Vic) (
the Act), every person has the right to request
access to documents held by Victorian public sector agencies and Ministers. This right of access is
subject to exceptions and exemptions necessary to protect essential public and private interests.
Before you make a request
We publish certain information and documents on our website and make other information or
documents available upon request without the need for you to make a request under the Act.
Before you make a request, visit our website or contact us to see if the information you would like to
access:
• is publicly available on our website;
• is available for purchase;
• is available for inspection;
• is available under an informal release scheme; or
• can be provided to you by telephone or email outside of the Act.
Providing information outside of the Act is called proactive release and informal release. For more
information on what proactive and informal release means, read the Office of the Victorian
Information Commissioner’s (
OVIC)
Proactive and Informal Release of Information – Guidance for
the Public.
If you cannot access information outside of the Act, please continue reading to learn how to make a
valid freedom of information (
FOI) request.
Making a valid request
Under section 17 of the FOI Act, a request must meet three requirements to be valid:
1. your request must be in writing;
2. you must provide sufficient information about the documents you are requesting to enable us to
identify and locate relevant documents; and
3. you must pay the application fee, or if payment of the application fee would cause you hardship
you can request us to waive the fee in full or in part.
Visit OVIC’s website for more information o
n how to make a valid FOI request.
After you submit a request
After you submit a request, we will assess it to ensure it meets the requirements outlined in section
17 of the FOI Act. If we determine that your request is not valid, we will notify you within 21 days
from the date we received your request and provide you with assistance to help you make the
request valid. If your request is valid, we will begin processing it.
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Timeframes
We have 30 days from the day after we receive your valid request to provide you with a decision.
However, we can extend this time by up to 15 days if we need to consult with third parties whose
information may be contained in the requested documents. We may also extend this time by up to
30 days with your agreement. We wil let you know if the timeframe changes.
Other charges
We may require you to pay certain charges before access is provided to the requested document(s).
For example, we may charge for providing copies of the document(s) or supervising an inspection of
the document(s). If these charges exceed $50.00, we will notify you and request that you pay a
deposit before proceeding with your request.
Collection, use and disclosure of your personal information
St Vincent’s Hospital Melbourne respects your privacy.
Col ecting information from you, such as your medical history, helps us provide you with the best
care and treatment.
We keep your information in paper and electronic medical records. These records are always stored
securely.
Not all staff can access the information in your medical record. Only staff involved in your care will
access your information.
We train our staff to keep your information safe and secure. Under our Code of Conduct, staff must
maintain your privacy and obey the law.
If you would like more information about privacy or to make a complaint, you can cal our Patient
Liaison Officer on (03) 9231 3108.
We treat all complaints seriously. If we cannot resolve your complaint or you have serious concerns,
you can also contact the Victorian Health Services Commissioner on (03) 8601 5200.
A copy of our ful privacy policy can be accessed here:
Your Policy - St Vincent's Hospital Melbourne
(svhm.org.au)
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1. Contact details
Your details Title:
First Name(s):
Surname:
Organisation (
if applicable):
Email address:
Contact number(s):
Postal address:
Suburb:
State/Territory:
Postcode:
Preferred contact method:
Do you need an interpreter?
If yes, what language?
Details of your representative (if applicable) If you are using a representative like a parent, guardian, lawyer or any other person who is acting
on your behalf, please advise who they are. If you are completing this form as the applicant’s
representative, advise who you are.
Title:
First Name(s):
Surname:
Organisation (
if applicable):
Email address:
Contact number(s):
Postal address:
Suburb:
State/Territory:
Postcode:
Preferred contact method:
Relationship to applicant:
Your authority for representative to act (if applicable)
Please complete this section if a representative is assisting you with your request.
I give permission and authorisation for my representative to act on my behalf and have access to
any information concerning my request.
Applicant
Representative
Name:
Name:
Signature:
Signature:
Date:
Date:
Witness
Witness
Name:
Name:
Signature:
Signature:
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2. The documents you are requesting to access
Please identify, describe or outline the document(s) you are seeking to access.
Your request must provide sufficient information for us to be able to identify and locate all relevant
document(s). When writing your request, be specific about which document(s) you are seeking and
include as much information as possible. Think about:
• what the document(s) relate to (for example, a complaint you made, or a particular project);
• the date range in which the document(s) may have been created;
• where the document(s) might be located (for example, in a particular email account, with a
specific person, or held by a business or work unit); and
• the type of document(s) you seek (for example, an email, report, CCTV footage).
Please avoid using wording such as ‘al documents’ because your request may result in it being too
large for us to process, or it may not be specific enough for us to identify the document(s). If you are
not sure how to frame your request, please contact us.
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3. Additional information to assist us
Optional: please provide background or contextual information to assist us in processing your
request. This could include your reasons for seeking access to the document(s) and what you intend
to do with the document(s). Providing additional information may assist us to identify and locate
document(s) relevant to your request. It may also assist us to identify other ways you may access the
requested document(s) outside of the FOI Act.
It may be helpful to exclude certain documents or information from your request if it isn’t
particularly necessary or relevant. This may allow us to process your request more quickly by
potential y reducing the number of documents to assess or removing the requirement for us to
consult with third parties. Do you require access to:
• draft documents Yes / No
• duplicate documents: Yes / No
• commercial information relating to third parties: Yes / No
• personal information relating to third parties: Yes / No
4. Proof of identification (if applicable)
If the documents you are seeking access to relate to you personally, you may need to provide us
with a certified copy of your identification. We may not be able to provide access to the requested
document(s) if we cannot verify that you are the person the subject of the document(s).
5. Edited copies
The document(s) you requested may contain exempt or irrelevant information. Under section 25 of
the FOI Act, we can provide edited copies of document(s) with exempt or irrelevant information
removed. However, we are only required to do this if you indicate you will accept an edited copy of
the document(s), and if it is practicable for us to make edits. If you don’t agree to receive an edited
copy, we may decide the entire document is exempt and refuse access to it in ful , even if there is
some information that could be released to you.
In the event we consider the document(s) you requested contain exempt or irrelevant information,
do you agree to receive an edited copy with the exempt or irrelevant information removed?
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I agree / I do not agree to receive access to an edited copy of a document with exempt or
irrelevant information removed in accordance with section 25 of the FOI Act.
6. Form of access
Please tell us how you would like to receive a copy of the document(s) we decide to release to you.
This might be inspecting the document(s), a hardcopy sent by post, a copy sent by email, the
document(s) copied onto a CD or USB to be picked up or sent by post. We wil try to accommodate
your request but may have to provide access in another way.
7. Application fee
The application fee for making a request for access under section 17 of the FOI Act is $31.80.
We will send an invoice for the application fee which can be paid by bank cheque, money order,
bank transfer, or cash.
Alternatively, if paying the application fee would cause you hardship, you may request that we waive
the application fee in full or in part. If you request a waiver, please provide evidence to show why
paying the fee would cause you hardship, such as a concession or healthcare card or a statutory
declaration outlining why payment would cause hardship. We will assess your fee waiver request
and let you know the outcome.
8. Submitting your request
You can send your request by email or post. If you are unable to send your request via these
methods, please contact us to discuss other options.
Email: xxx.xxxx@xxxx.xxx.xx
Post: PO Box 2900 Fitzroy VIC 3065
In Person: Reception desk, In-patient building, 41 Victoria Parade Fitzroy VIC 3065
Further assistance
If you have a question about making a request or want to discuss your request further, please
contact us on (03) 9231 5588 or xxx.xxxx@xxxx.xxx.xx
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