ࡱ> @B?  bjbjSS 2511888LLL8$Ls"!!!!!!!$5$&"8^"-"R8 p!:Z, WlHpv n C"0s"R'''8""s"' : CONSENT AND LIMITED CONFIDENTIALITY FORM At the beginning of each interview, the Authorised Clinician will inform participants over ten years of age of the nature, purpose and process of the assessment. The Clinician will also inform the participants in the interview or observation that any information given in the interview or assessment may be included in the report to be sent to court. The Authorised Clinician will ask the participants to sign below to confirm that that they have been given this information and that they consent to participate in this assessment. CHILD__________________________________ Signature (over age 10) CHILD_________________________________ Signature.... (over age 10) FATHER _______________________________ Signature... MOTHER________________________________ Signature... GRANDPARENT__________________________ Signature GRANDPARENT__________________________ Signature OTHER_________________________________ Signature... OTHER_________________________________ Signature AUTHORISED CLINICIAN: ____________________________ Authorised Clinicians Signature: ... Date: //...      Sydney Childrens Hospitals ǿ Parramatta Childrens Court 2 George St Parramatta Locked Bag 4001 Westmead NSW 2145  Phone: +61 2 8688 1530 Fax: +61 2 8688 1520 Email: schn-childrenscourtclinic@health.nsw.gov.au Form No. ADM.004PTA )*+.?Egm + ? @ A ( " # ? ٻ٧٧ɟɁwhAB* CJphfhA^JaJhAB*CJphffjh(UhjhUhACJ^J h^J h\l^J h1b^Jheh1bhA he^J hQ_^J hA^JhA5CJ\^Jhe5CJ\^JhsA/5CJ\^J,*+ A B C ( )   i]ii]igd1bi]i4$$d%d&d'd-D1$M NOPQ]a$) * + l m n o 2 3 4 5 t u v $a$ i]i^` i]i^ i]i i]ii]i # ? K V W g y z | }  9r $ 7$8$H$]^a$$7$8$H$]^a$$7$8$H$]^a$ $ 7$8$H$^ a$$a$? 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