Queensland Health (QH) is required to manage your personal information in accordance with the Information Privacy Act 2009 and the Hospital and Health Boards Act 2011, Part 7 Confidentiality. QH is collecting the personal information on this form to assist in chart preparation for your pregnancy booking in visit and to assess your individual pregnancy health care needs. This form will be printed and filed in your patient medical record. Some of your personal information on your medical record may be given to carers, guardians or other government departments who provide associated services that require your information for the purpose of providing a health care service. Your information will be disclosed without your consent, if authorised or required by law. For further information about privacy and your health record please ask for a copy of the Queensland Health Privacy Brochure or visit www.health.qld.gov.au.