Terms, Admission and Consent

1. If you are a member of a medical aid or a dependant on someone’s medical aid, this practice will send the account directly to your medical scheme. If you do not want us to do this, please let us know immediately after you have seen the Therapist and before you leave the practice.
2. With some medical aids we do NOT submit the account, and you must pay us, and then claim back from the medical scheme. Please ask if your scheme is one of those schemes.
3. This practice charges 100% scheme rates, alternatively a flat hourly rate as stipulated below. Sometimes they do not pay at all. Note that you will still have to pay the full account if your scheme does not pay in full. You may also have to pay us a portion of the account if the scheme did not pay us the total amount.

4. Our cash consultation fees: Initial Assessment R 950.00 and follow-up sessions R 710.00 p/h, which will increase by 10% as of 1 January each year, excluding materials and programs. Alternatively, we ask medical aid fees according to scheme rate, which is available on your statement. The fees we charge may change from time to time depending on materials used in sessions.
5. Please note that the above cash fees are separate from functional capacity evaluations and full school assessments. Please enquire about the fees beforehand.
6. In some cases we need to do something different or something more to help you. In such cases we will provide you with a quotation that will state what we estimate the cost would be, but also what could make the quotation go up or down. If you are uncertain of a quotation or fee, please talk to your therapist about the cost of your therapy.
7. The cost of materials that we use during therapy may differ and we will in each case inform you of the cost thereof, if it is not included in the consultation fee.

• I am aware that the practice will invoice the medical aid for therapy received in hospital.
• I am aware that the account for which I am liable is separate from the hospital account.
• Newborns: the parent is responsible for adding the newborn to the medical aid within 30 days of birth. Failure to do so will result in the account being sent to the principal member.

8. You must pay us within 30 days (one month) after we have given you an account. You can pay in cash at the practice, or make an internet banking transfer (EFT) — our bank details are on the account. We regret we do not accept any cheques.
9. If you do not pay us, interest at the rate of 1.5% per month will be levied after 60 days on all amounts in arrears, calculated from the date of the first rendered account.

10. If you do not pay us within 90 days, we may hand you over to a debt collecting agency or a law firm to get the outstanding debt. All costs of the debt collector and/or lawyer will be added to your account.
11. If you have any special circumstances that prevent you from paying us, please let us know immediately, so that you can make repayment arrangements. Interest will still be charged on these outstanding accounts.
12. The Practice reserves the right to terminate therapy due to non-payment without notice.

13. You must keep your appointments and come to the practice on time. If you have to cancel the appointment, you must inform us at least 24 hours before, or by 08:00 on the day of the appointment. If you do not do this, we will still send you an account for the full fee we normally charge. If you are prevented from making the appointment due to an accident or similar emergency, we will not charge you. It will then be your responsibility to reschedule the appointment.

Therapy will start with an assessment which includes the below, to take place on pre-agreed dates:

14. Intake interview: it is preferable that both parents attend this meeting in the case of a child. It will take approximately 45 minutes.
15. Assessment of you / your child: a range of age-appropriate standardised assessments are used. The duration of the assessment depends on multiple factors such as age, response to assessment tasks and the assessments that need to be completed (range: 1 to 3 hours — may be broken up into multiple sessions).
16. Feedback: it is preferable that both parents attend this meeting in the case of a child. The results of the assessment are discussed in detail and recommendations are made based on the assessment findings.

17. Before we start with therapy: we will talk to you about the options you have and the benefits of each option, and we will also tell you if there are any risks (such as risk of hurting yourself or pain) or negative aspects of the therapy.
18. You will then agree to the therapy after the discussions, or you may decide to refuse therapy. If you refuse, we will explain to you what might happen if you do not undergo therapy. Therapy often means more than one session and it may be important that you commit to a series of sessions.
19. Remember that: no therapy can be 100% guaranteed; you always must follow the instructions and warnings of the therapist carefully; the success of therapy depends on your co-operation and being honest with the therapist — if you feel uncertain, please make a follow-up appointment with the therapist; and you must complete a series of therapy sessions if this was recommended by the therapist, as stopping therapy before the end of all the sessions may mean that the therapy will not be successful.

20. As the parent, you are entitled and encouraged to maintain regular contact with the Practice in order to keep up to date with your child’s treatment and progress. You are encouraged to attend therapy sessions to gain a better understanding of the therapeutic process; please arrange this with your therapist.
21. WhatsApp will be used for updates and sharing of information pertaining to you / your child’s therapy. Kindly note that WhatsApp has embedded end-to-end encryption which ensures only the persons you’re communicating with can read or listen to what is sent, and nobody in between, not even WhatsApp.
22. The success of therapy depends on your cooperation and being honest. Please inform your therapist of any significant events or changes that affect you / your child. If you are uncertain about anything, please make an appointment with or email your therapist to discuss.

23. Every person that gets therapy in this practice has the right to confidentiality (this means to have your personal information kept private, even from family members and employers). Nothing that you share with the Therapist will be passed on to anyone, unless:
    1. You agree in writing that your information can be shared (e.g. with a schoolteacher, an employer or any other specific person or entity).
    2. The law on medical aids forces us to provide certain information to the medical aid. When we submit your account to the medical aid, the account includes personal information, such as what your health status is, and the codes (numbers) that indicate the specific therapy you got.
    3. When we receive an order from a court to disclose your information, we have no choice but to provide it.
    4. When a specific law makes it compulsory to report things, such as TB, cancer or child abuse or child neglect.
    5. Communication with the referring doctor or other healthcare professional, insofar as it is necessary and in the interest of the patient.
    6. A service provider that processes your information on our behalf, on our instruction and under a written agreement — for example the practice’s record-keeping and website systems, and the artificial-intelligence service described in clause 25.3 below. These providers may process your information outside South Africa. They may not use it for their own purposes, and may not use it to train artificial-intelligence systems.
24. When anyone else, or any other business (such as an insurance company, your employer, a lawyer) wants your information, we will contact you to get your written permission that we can give the information to such person or business.
25. The Practice takes the protection of personal information seriously as required in terms of the Protection of Personal Information Act No. 4 of 2013 (“POPIA”, as may be amended or substituted from time to time), as well as in terms of our role as a health care provider. Your and our rights and obligations are set out in the Privacy Notice which can be requested from the practice.

26. By law, children from the age of 12 can seek healthcare help on their own, if they are able to understand what therapy means. Parents still must pay for this cost. Unless one of the parents has completed the information above, any one of the child’s parents will have to pay the account for the child’s therapy. It does not matter if the parents are divorced or not married: any one, or both, may have to pay the account.
27. The above will be explained to children and parents or caregivers. If the child is ok with it, aspects of the proposed therapy and how therapy went will be shared with the parent(s) or caregiver.

25.1 Occasionally the therapist may wish to film / record or take photographs of the client during therapy. This is usually for assessment purposes and clinical reasoning. The photographs, recordings and film will be stored on devices with password protection.

25.2 The therapist provides professional training to schools, other professionals and parents. Learning is greatly enhanced where participants can see real-life examples. Please indicate if you are happy for the therapist to use the following media for these purposes. Your rights will not be affected at any time if you answer no.

I agree that the practice collects, keeps and uses my (or my child’s) health information to provide treatment, to run the practice (appointments, accounts and medical-aid claims) and to communicate with other professionals involved in my care. It is kept confidential and protected as the Protection of Personal Information Act (POPIA) requires.

I agree that my records are kept electronically in the practice’s own secure system, hosted by Google Cloud. Records are stored in South Africa; uploaded documents and photos are stored in the United States.

Please read each of the three sections below and choose Yes or No for each one. Each choice is separate, and every one of them is optional. Whatever you choose, your treatment will be exactly the same.

25.3A What the AI is, and what it is not. Where these clauses refer to an “AI service”, this means Google’s Gemini artificial-intelligence service, accessed through Google Cloud Vertex AI. The AI produces a draft for your therapist to read. It does not make any diagnosis, assessment or treatment decision. It is not used to score, rank or prioritise patients, or to decide whether you receive treatment or what treatment you receive.

25.3B Your therapist decides everything, and is responsible for everything. Your therapist reads, corrects and approves every note and every document. She remains fully responsible for the content and accuracy of your clinical record and of every document that leaves this practice, no matter how the first draft was produced. Nothing in the indemnity clause of these terms limits that responsibility.

25.3B(i) No decision about you is made by a computer. In particular, the AI does not decide, and is not used to decide, any of the following — your therapist makes every one of these decisions personally: your diagnosis; the outcome of any assessment, test or score; what treatment you receive, or whether you receive treatment at all; whether you are referred to anyone else, and to whom; how urgent your case is, or where you sit on a waiting list; whether you are taken on as a patient, or discharged; whether you are booked off work or school, and what any medical certificate says; what is claimed from your medical aid, or what is said in a motivation for funding; and any judgement about risk to you or to anyone else.

25.3B(ii) You never deal with the AI. The AI is a tool your therapist uses to help her write. It is never presented to you as a therapist, a doctor or any other kind of healthcare professional. It does not answer your questions, give you advice, or speak to you. Everything it produces goes to your therapist and nowhere else. If this ever changes, we will tell you and ask you again — it would not be covered by anything you agree to here.

25.3B(iii) We send it as little as possible. Only the information actually needed for the particular task is sent to the AI service. We do not send your whole file when a part of it will do.

25.3C Where your information is processed. The AI service is provided by Google. Processing takes place at Google’s data centres, which are located in various countries around the world, and not currently in South Africa. Your information therefore leaves South Africa when it is processed. This is permitted under section 72 of POPIA because Google is bound by a written agreement with this practice which requires Google to protect your information to a standard substantially similar to what POPIA requires, including if Google passes it on to anyone else. By choosing Yes below, you also consent to that transfer. We intend to move this into South Africa. Google Cloud operates a data centre in Johannesburg. As soon as the AI service this practice uses becomes available there, we will move the processing into South Africa and tell you that we have done so.

25.3D What Google may and may not do. Google acts as an “Operator” under POPIA and may only process your information on this practice’s instruction, to produce the draft, and for nothing else. Google does not use your information to train its AI models, and may not use it for its own purposes or pass it on to anyone except as the written agreement with this practice allows.

25.3D(i) Checking for misuse — and what that means for you. Google runs automated checks on what is sent to it, to detect people misusing the service. In the ordinary course your information is processed and not kept. But if those automated checks flag something that Google considers needs looking into, Google may keep a copy of what was sent for up to 90 days, stored in the same region the practice has selected, in order to check whether its rules have been broken. Where that happens, authorised Google staff may read the flagged material. This does not happen to everything sent — only to material its automated checks flag. Anything kept in this way is still never used to train AI models. We tell you this because we would rather you knew exactly what you are agreeing to than be given a promise we cannot stand behind. The practice is applying to Google to be exempted from this logging altogether; if that is granted, this clause will be changed and patients will be told.

25.3E Does the AI “learn” from me? No. The AI models used by this practice are what is called locked learners: the model does not change or update itself from your information or from anything that happens in this practice. It is not a “continuous learning system”. Nothing you say in a session becomes part of the AI’s knowledge, and nothing about you can appear in anyone else’s results.

25.3F What the AI is not good at. Speech recognition is less accurate with some accents, and when a conversation moves between Afrikaans and English — which happens often in this practice. It is less accurate with children’s speech, particularly younger children and children who have speech or language difficulties. Background noise and movement during a session reduce accuracy further. The AI can sometimes produce text that reads well but is wrong — it may put words in the wrong person’s mouth, or fill in something it could not hear. It was not built or tested specifically for South African occupational therapy. More generally, AI output may contain mistakes, leave things out, make assumptions that do not apply to you, or reflect bias in the material it was built from, and it must never be treated as accurate simply because it reads well. Because of all of this, your therapist reads every draft against her own memory of the session, corrects it, and approves it. The corrected version is what goes into your record. The AI’s draft is never the record. No AI output is relied on for anything to do with your care until an appropriately qualified health professional has checked it.

25.3G Security. Recordings, transcripts and notes are encrypted while being sent and while stored. The AI service is reached only through this practice’s own secured server and never from an ordinary web browser. Only your therapist’s signed-in account can request a transcription, and this is checked on every request. Access to your recordings and notes is limited to your therapist.

25.4 To keep accurate clinical records while staying focused on you / your child during the session, the therapist may use an AI service to record the session, transcribe it, and produce a draft summary. The draft is a working document only, and clauses 25.3A to 25.3G apply.

25.6 How long the recording is kept. The practice deletes the audio recording as soon as your therapist has approved the note, and in any event within 30 days of the session. The approved written summary forms part of your clinical record and is kept for the period the HPCSA requires — not less than six years from your last consultation; if you were a child, until your 21st birthday; and for a patient who is mentally incapacitated, for that patient’s lifetime.

25.7 Your choice. This is entirely voluntary. You may say no, and you will receive exactly the same treatment. You may withdraw at any time, and you may ask the therapist to stop or pause recording at any point during a session, without giving a reason. Withdrawal applies from that point onwards; notes already approved remain part of your clinical record.

25.8 We will ask you again each time. Even after you sign this, your therapist will tell you at the start of any session she wants to record, and check that you are still happy. You may say no on any particular day without changing your answer here, and without giving a reason.

25.9 Other people present. If a parent, caregiver or any other person takes part in the session, their voice will also be recorded. They will be told before recording starts, and recording will not go ahead if any of them does not agree.

25.10 Children. Where the patient is a child, the parent or legal guardian gives this consent. A child aged 12 or older will also have this explained to them in a way they can understand, and recording will not proceed if the child objects, whatever the parent has decided. The child’s answer is noted in the file.

25.11 What this is. Separately from recording individual sessions, the therapist may use the same AI service to read through your existing file — your history, previous session notes, and the information you gave on this form — and produce a summary for the therapist’s own use. This helps the therapist prepare for a session and see your progress over time without having to re-read the whole file. Clauses 25.3A to 25.3G apply, including that your file is sent outside South Africa to be processed.

25.12 What it produces. The summary may set out your relevant history, the issues currently being worked on, your social and home context where this is relevant to therapy, and a list of information that appears to be missing from your file. Identifying missing information is a reminder for the therapist to ask you about it. It is not a conclusion about you, and no gap in your file is treated as a finding.

25.13 Limits. The summary is a reading aid for your therapist only. It is not sent to anyone, does not replace any part of your clinical record, and is not used to assess, score, rank or prioritise patients, or to decide whether you receive treatment.

25.14 Drafts are not kept. The summary is a working document. It is not added to your clinical record and is deleted when it is no longer needed.

25.15 What this is. The therapist may use the AI service to prepare a first draft of written documents about your care. These include referral letters to other healthcare professionals; feedback and progress letters to you, a school or another therapist; assessment and progress reports; motivations to your medical aid for funding; discharge summaries; sick notes and medical certificates; and general correspondence about your care. Clauses 25.3A to 25.3G apply, including that the information used to prepare the draft is processed outside South Africa.

25.16 The therapist writes the final document. Every document is read, corrected, completed and signed by your therapist before it is issued. Nothing is sent automatically. Your therapist is fully responsible for the content and accuracy of every document that leaves this practice, regardless of how the first draft was produced. Where a document is a medical certificate or sick note, it remains your therapist’s own professional certificate, as required by the HPCSA.

25.17 These documents go to other people. By their nature these documents are shared outside the practice — for example with a doctor, a school, your medical aid or your employer. This sharing is governed by the confidentiality terms in clauses 23 and 24 above, which apply in full and are not changed by the use of AI. You will be told what is being sent and to whom.

25.18 No decision is made by a computer. No decision affecting you is made solely by automated means. In particular, the AI does not decide whether you are booked off work, whether a referral is made, or what is claimed from your medical aid. Your therapist makes every such decision personally. You may ask how any document about you was prepared, and you may object to a document produced with AI assistance and ask that it be redone without it.

25.19 If something is wrong. If you believe a document contains an error, please tell the practice. Your therapist will correct it and, where the document has already been sent to someone else, will send the corrected version to that person and tell you that this has been done. The same applies to an error in a session note.

25.20 Each choice is separate. You may agree to some of the above and not others. Refusing any or all of them will not affect your treatment in any way, and no service will be withheld, delayed, or charged differently because of your choice.

25.21 Information already in your file. If you have been a patient of this practice before these AI features were introduced, information already in your file will only be processed in the ways described above if you agree here. If you do not agree, your existing records will be read and used by your therapist in the ordinary way, without AI assistance.

25.22 Withdrawing. You may change any of the above choices at any time by telling the practice. You do not have to give a reason. A change applies from that point onwards. Documents and notes already approved and issued remain part of your clinical record and, where already sent, cannot be recalled.

25.22A Withdrawing consent is not the same as deleting your file. If you withdraw one of the consents above, we stop using the AI in that way for you straight away. But we are required by law and by the HPCSA to keep your clinical record for a set period, so withdrawing your consent does not mean your medical records are deleted, and we are not permitted to delete them on request. What has already been written, checked and approved by your therapist stays part of your record in the ordinary way. If you want to know exactly what is held and why, please ask, and we will go through it with you.

25.23 Drafts. AI-generated drafts that are not approved and used are deleted and do not form part of your clinical record. Only your therapist’s approved version is kept.

25.24 Your rights. You may at any time ask what information this practice holds about you and be given a copy; ask that it be corrected, or in some circumstances deleted; ask how the AI was used in any part of your care — not only in documents — including what it was given, what it produced, what its known limitations and biases are, and what risks come with it (you do not need a reason to ask, and you will be given a straight answer); object to your information being processed with AI assistance; withdraw any consent given here; and ask any question about any of this and have it answered.

25.25 If you are unhappy. Please speak to the practice first — most things are easiest to put right that way. You also have the right to lodge a complaint with the Information Regulator (South Africa) about how your personal information has been handled, and with the Health Professions Council of South Africa (HPCSA) about the professional conduct of the practitioner. Using these clauses does not affect either right.

25.26 If something goes wrong with security. If your personal information is ever accessed by someone who should not have it, the practice will tell you and the Information Regulator as soon as reasonably possible, and will tell you what happened and what is being done about it.

25.27 Language. If you would prefer this document in Afrikaans, please ask — one will be given to you. Do not sign anything you do not understand. Please ask as many questions as you need to.

I understand that assessments and/or therapy may involve physical exertion, which can result in a temporary exacerbation of symptoms such as pain, fatigue, or shortness of breath. I acknowledge that participation in assessment and therapy is at my own risk and by signing this document, we indemnify Berna du Plessis and her respective employees and representatives working within the Practice from any and all loss, costs, claims, injury, damage or liability sustained or incurred by myself / my child resulting from his/her participation and/or resulting from any act.