Request to Access Client Case Notes Form

You must submit this form to access a client's case notes created by a previous student at the same agency / school. Make sure to arrange a suitable time ONSITE at CMI with your Supervisor (or Placement Coordinator if your ) to view the client case notes prior to submitting this request. NOTE: Admin requires at least 3 days notice to process this request.

NOTE: Case notes cannot be viewed via online screen sharing facilities unless due to exceptional circumstances that prevent you from attending onsite and a disclaimer has been signed off by student and relevant staff members.

You must have consent from the client or client's parent / guardian and upload the relevant completed and signed 'Release of Information form' and provide the time discussed and scheduled to view the case notes. NOTE: Client case notes can not be taken off campus and you are prohibited from taking copies/images of the case notes. You may only make your own individual notes/observations.

All forms can be found on my.CMI https://my.cairnmillar.edu.au/knowledgebase/general-placement-forms-guides/. Please speak to your Supervisor if you're unsure of what 'Release of Information form' you require.

Student ID: *

Your Full Name: *

Your Student Email: *

Course *

Currently Enrolled Placement Unit * Currently Enrolled Placement Unit

Name of Placement Agency / School: *

Who created these client case notes? *

Previous Student created these client case notes while at this placement

These are client case notes I created while at this placement

Name of Client (de-identified) *

Please provide the same de-identified name provided when you submitted your client case notes eg M Smith, or Mary S or MS. If you had more than one client with the same de-identified name please provide more clarity.

How were the case notes submitted to CMI? *

USB stick

OneDrive link

OtherOther

NOTE: If submitted on USB, your case notes may not be able to be accessed during Covid-19 as these case notes are locked on Campus.

Full Name of Past Student: *

What Course was this Student enrolled in? * What Course was this Student enrolled in?

When did the past student finish at this Agency/School? *

Provide year with approximate month and / or semester 1 or 2?

Is your Supervisor on-site at Cairnmillar Institute (i.e. CMI staff)?

Yes

Name of your Supervisor: *

Your Supervisor's Email: *

Name of Placement Coordinator: *

If your Supervisor is not an on-site Cairnmillar staff member, you will need to have arranged a time with your Placement Coordinator.

Email of Placement Coordinator: *

Have you arranged a time ONSITE to view these case notes? *

Yes

Your Supervisor must be on-site at Cairnmillar Institute to provide supervision while you view the client case notes.

What date and time have you arranged to view the client case notes? (Note: Admin requires at least 3 days notice to process your request) *

Upload Completed 'Release of Information' Form *

Maximum file size: 5.24MB

Form must be completed and signed before uploading. Must include signature of consenting adult client or parent/guardian of client under age of 18 years of age.

This request can not be completed at this time.

Please arrange a suitable time with your Supervisor or Placement Coordinator before submitting this request.

Declaration: *

I declare that I will view this case notes onsite while supervised and will abide by the rules outlined above and keep the client case notes confidential at all times and that the notes will be returned to the School Administration Officer by my Supervisor / Placement Coordinator once viewed by me.

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