Privacy complaint

If you are concerned that your personal information has not been protected or that NT Health* has breached your privacy, please complete the below online form to make a complaint under the Information Act 2002 about a breach of your privacy.

*NT Health includes: the Department of Health (DoH), Central Australia Health Service (CAHS), or Top End Health Service (TEHS).

Contact details

Title *

First name *

Surname *

Phone *

Mobile

Email *

Address

Preferred method of contact *

Complaint details

Details of complaint
Please provide as much detail as possible about the complaint

What happened

When it happened (including dates)

What personal information was affected

Include names of individuals involved if known

What area of the NT Health

Note: the clearer the information provided the easier it is to process the complaint. You can attach another sheet of paper with more details if necessary.

Is this a complaint on behalf of another person? *

The name of the person you are making a complaint on behalf: Please complete if you are making a complaint on behalf of another person.

What is your relationship to the person? Please complete if you are making a complaint on behalf of another person.

Supporting documents

Time limit

NT Health generally will not accept a complaint if it is more than 12 months since the incident unless there are sufficient grounds for the delay is. If the incident occurred more than 12 months ago, please provide the reason for the delay in making this complaint.

Date you became aware of the incident. *

Day Month Year

How you became aware of the incident: *

Desired outcomes * What actions and outcomes are you seeking from NT Health as a result of this complaint? If you are unsure or would like to discuss outcome options please contact the Information and Privacy Unit on (08) 8999 2880.

Submitting complaint * To the best of my knowledge, the information provided in this Privacy Complaint form is true, correct and accurate.

I have checked all information and completed required fields before submission of complaint.

Last updated: 06 October 2020

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