Fees and Payment (Billing Policy):

1. We charge a practice rate unless we have a contract with your medical aid that clearly outlines the applicable scheme rates. Feel free to ask us if we have a contract with your medical aid or for an estimate for any planned treatments. The estimates may change if the duration of service, or planned treatment changes. It is not possible to know beforehand exactly what treatment will be needed or how long the surgeries will take.
2. We will submit your account directly to your medical aid using our medical billing software, unless you wish to pay as a private patient, and then submit the claim yourself, please inform us of such a decision before the consultation.
3. Note that your medical aid may require authorisation for consultations and sometimes motivational letters for certain treatments.  We will supply the needed documentation, but you will be responsible to obtain the required authorisation. Please note that schemes always state the authorisation is not a proof of payment and may have specific rules for specialist visits and procedures that may indicate co-payments or limits for specific procedures. You confirm that you understand that you remain responsible for the full amount, payable within 30 days.
4. You confirm that if you are a private patient, fees are payable on the day of service immediately after the examination or procedure.
5. When we make use of other facilities or service providers (Hospitals, pharmacies, laboratories and anaesthetists or tests that cannot be done at this practice), they will charge their fees separately. You will receive separate accounts payable directly to these providers by yourself or your medical aid.
6. We may charge a printing fee to print specialised test results.
7. We make use of SMS’s, emails, WhatsApp’s and phone calls to remind you of appointments and inform you about any outstanding accounts. If you have any queries or difficulty in settling your account, feel free to contact us, as soon as possible.
8. Accounts not settled within 60 days will be handed over for debt collection.

Cancellations:

9. Appointments not cancelled 24 hours in advance may be charged for.

Children and Healthcare:

10. You confirm that you understand that, as a parent or legal guardian, you are legally liable to cover the cost of your child’s healthcare. This practice does not know what the specific arrangements are between unmarried-, married-, divorced-, foster, other parents, guardians or caregivers. Unless a signature of the person responsible for the account, in terms of a parental agreement, is provided, the parent / guardian / caregiver who signs the practice forms and accepts these terms and conditions will be held legally liable for the cost of care provided and the account will be addressed to that person.

Protection of Personal Information Act No 4 of 2013 (“POPIA”)

11. As patient or parent/legal guardian of the Patient you accept that your personal information needs to be processed by the practice.
12. We respect your right to privacy and therefore aim to ensure that we comply with the legal requirement of the POPI Act, which regulates the way we collect, process, store, share and destroy any personal information you have provided to us.
13. You acknowledge that as Patient or parent/legal guardian of the Patient your personal information needs to be processed by the practice and therefore grant the following consent:

• I hereby give my consent for all doctors and employees practising as Dr P Roux Oogheelkundige Praktyk (collectively referred to as the “Practice”) to Collect, Send, Process or Retrieve my/ the Patient’s personal information (as defined in the Protection of Personal Information Act No 4 of 2013 (“POPIA”) (“Personal Information”) that includes but is not limited to: full name(s), identity number(s), birth date(s), cell phone number(s), email address(es), physical address(es), postal address(es), occupation, employer details, medicine(s), treatment, HIV status and all further confidential Medical Information and Medical History pertaining to myself (“Medical Information”) from referring doctors and specialists, including but not limited to all medical reports, pertaining to the Patient and/or myself to or from the below mentioned Third Parties’ in connection with my or the Patient’s care, to enable the Practice to provide the necessary health services, medical and administration facilities (“Services”) to me and/or the Patient.

I furthermore understand that:

• My consent is voluntary, and I understand that I can withdraw it at any time.
• the Personal Information will be transferred electronically and/or Processed (as defined in POPIA) in accordance with the regulations of POPIA and any other applicable legislation.
• the Practice will not be able to render the necessary Services to me and/or the Patient, if I don’t provide the necessary Personal Information to it or its employees, directors, doctors, trustees, researchers, consultants, doctors, specialists and Third Parties.
• My Personal Information and Medical Information will be retained for medical, statistical and academic research purposes. If it is not required for the aforesaid purpose(s), it will be destroyed in accordance with the rules set out in POPIA and the rules of the applicable governing medical profession(s) and/or their successors and the guidelines set out by the Health Professions Council of South Africa (“HPCSA”) that require us to retain your Personal Information and Medical Information for a period of at least 5 (five) years.
• I have the right to access my Personal Information and Medical Information at any time in accordance with the relevant provisions contained in POPI and the Promotion of Access to Information Act No 2 of 2000 (“PAIA”) and that I have the right the Promotion of Access to Information Act No 2 of 2000 (“PAIA”) and that I have the right to rectify any details with the Practice at any time.
• I have the right to lodge a complaint to the Information Regulator at JD House, 27 Siemens Street, Braamfontein, Johannesburg, 2001 or via email: complaints.IR@justice.gov.za in accordance with Section 18 of POPIA.

INDEMNITY:

By signing this Consent Form, I am allowing the Practice and any of the Third parties (as listed above), access to my/the Patient’s:

• confidential Personal Information and
• Medical Information (as set out above).

By giving my consent, I hereby indemnify the Practice for any consequences arising from the unauthorized access of my/the Patient’s reports and/or any of my/the Patient’s Personal Information (as defined in POPIA) and hold the Practice harmless against any liability therefrom) to the extent permissible under POPIA, suffered by myself and/or the Patient as a result of any of the Third Parties’ failure to comply with their statutory obligations contained under POPIA and/or any willful and/or negligent acts or omissions of any Third Party, their employees, contractors, agents or any duly authorized Operators (as defined in POPIA).

Purpose and Nature of Healthcare

14. Our doctors and/or staff members will inform you of your treatment/procedure and explain all possible consequences and aftercare instructions.
15. You confirm that you understand that your own behaviour may affect the outcome of the healthcare received. You agree to follow the instructions provided to you by our doctors and come for follow-ups, etc.  If you do not follow the instructions, you undertake to not hold the Practice and its staff liable for any negative consequences.
16. You confirm that you understand that in healthcare, results cannot always be predicted or guaranteed. Results also depend on how one’s body reacts to the treatment and/or procedures.

Patient / Client / Consumer duties (as per the National Health Act, 2003)

17. You confirm that you will adhere, and any instructions given to you by staff or healthcare professionals of the practice.
18. You have the right to ask questions and to have them answered. If you do not ask any questions, we will assume that you have understood everything.

Complaints & Concerns

19. If you have any questions regarding any of the information contained in this form, please do not hesitate to approach our doctors or one of the staff members to explain the content thereof.
20. We aim to ensure that all complaints and concerns are addressed appropriately. In this regard, please put any complaints in writing to the practice manager, Nienke de la Bat (nienke@drproux.co.za)

Last updated: 17/06/2025