AI Scribe Patient Information and Consent Form Template

What's in this template?

This is a free, 14 page consent kit for Australian practices whose clinicians use an AI scribe, built from RACGP criterion F11, the RACGP AI scribes fact sheet, Ahpra's AI guidance, the TGA's digital scribes page, the ACSQHC ambient scribe scenario, the ACRRM scribing checklist, the APS article on its AI guidelines, the Avant and MDA National guidance, and the eight state and territory listening devices Acts. It gives you the patient information sheet, the consent record, the clinician script and the written form, so you can run whichever version your medical defence organisation (MDO) asks for.

1. Cover and how to use this kit. Practice, scribe and vendor details, the MDO consulted, the consent method adopted, the boundary table below, and notes on legal status, F11 accreditation status and NDIS providers.
2. Part A: Patient information sheet. One page, plain language: what an AI scribe is, that the note is a summary and not a copy, that the clinician checks and remains responsible for it, and a question and answer table on audio, transcripts, storage, offshore processing, vendor training and who can see it.
3. Part B: Consent record. Patient details, what was explained, the decision (verbal, written or declined), who else was present and whether each agreed, a substitute decision maker block, a withdrawal block with the RACGP F11 actions, and a review-at-each-consultation box.
4. Part C: Clinician script card. A first-use script, a checklist, Avant's sample opening for comparison, the per-consultation check, what to say if the patient declines, suggested note entries, and ACRRM's optional label line.
5. Part D: Written consent form. For psychologists, whose body requires written, tool-specific consent, and any practice whose MDO asks for written consent. One form per tool, with separate lines for offshore processing and vendor product improvement.
6. Part E: Registration, booking, privacy policy and waiting room wording. A registration clause, a booking terms line, a privacy policy paragraph and a waiting room notice, each stating it informs patients and is not consent.
7. Part F: Recording consent law by state and territory. The eight-jurisdiction table below, how to read it, and how it sits alongside Avant's published summary.
8. Part G: What each body says about consent. A side-by-side table of 11 bodies (RACGP F11, the RACGP fact sheet, Ahpra, the TGA, ACSQHC, ACRRM, APS, APA, Avant, MDA National and MIPS), where they part ways, then roles, related documents and the approval signature block.
9. Appendix: Consent log. An optional landscape log (date, patient record number, clinician, tool, first explanation or per-visit check, verbal or written, given, declined or withdrawn, others present, action on withdrawal, initials), tied to RACGP F11.B monitoring.

Parts A to E are portrait and each starts on a new page so they can be printed separately. Parts F, G and the appendix are landscape.

Editable placeholder fields

The template uses yellow-highlighted {{ }}Placeholder{{placeholder}} fields: {{ }}Practice name{{practice_name}}, {{ }}AI scribe name{{ai_scribe_name}}, {{ }}AI scribe vendor{{ai_scribe_vendor}}, {{ }}Privacy officer{{privacy_officer}}, {{ }}Practice phone{{practice_phone}}, {{ }}Privacy policy location{{privacy_policy_location}}, {{ }}Clinician title{{clinician_title}}, {{ }}Mdo name{{mdo_name}}, {{ }}Mdo advice date{{mdo_advice_date}}, {{ }}Consent method{{consent_method}}, {{ }}Audio handling{{audio_handling}}, {{ }}Audio retention period{{audio_retention_period}}, {{ }}Transcript retention period{{transcript_retention_period}}, {{ }}Data storage location{{data_storage_location}}, {{ }}Overseas processing yes no{{overseas_processing_yes_no}}, {{ }}Overseas location{{overseas_location}}, {{ }}Vendor training yes no{{vendor_training_yes_no}}, {{ }}Scribe outputs{{scribe_outputs}}, {{ }}Audio and transcript sentence{{audio_and_transcript_sentence}}, {{ }}Overseas disclosure sentence{{overseas_disclosure_sentence}}, {{ }}Vendor training sentence{{vendor_training_sentence}}, {{ }}Safeguards{{safeguards}}, {{ }}Approved by{{approved_by}}, {{ }}Effective date{{effective_date}}, {{ }}Next review date{{next_review_date}}, and the sign-off dates.

Fill the Part A facts from the vendor's contract and its legal privacy page, and record that page's date. Do not fill them from a brochure or product page.

A patient document, not a staff policy

This kit sits on the patient side of the boundary. It does not decide which AI tool your practice may use, and it does not replace your privacy policy. Each document answers a different question:

A worked example: a clinician starts using a scribe on the practice's approved plan. The AI Acceptable Use Policy is satisfied. But the patient has only been told by a waiting room sign, and a carer in the room was never asked. In NSW that is exactly the gap this kit closes: consent from every principal party, asked in the consultation and recorded. The AI Acceptable Use Policy approves the tool, plan and settings; only then does this kit tell patients about the scribe and ask for, record and honour their consent.

What the law and the professional bodies actually require

Three reasons consent is not optional

Consent to an AI scribe in Australia stands on three legs: the profession's expectation, the state and territory listening devices Acts, and privacy law.

The profession is unambiguous. RACGP criterion F11.A, published 26 August 2026, requires that the practice "facilitates processes for members of the clinical team to obtain and document informed consent from patients when aspects of care will be delivered using AI". Ahpra goes further on the recording itself: "Informed consent is particularly important in AI models that record private conversations (consultations) as there may be criminal implications if consent is not obtained before recording, and the AI transcription software should include an explicit consent requirement as an initial step before proceeding" (Ahpra, Meeting your professional obligations when using Artificial Intelligence in healthcare, page reviewed 22 August 2024). The TGA's consumer guidance is direct: "Healthcare professionals must tell you when they plan to use a digital scribe during your care" (TGA, Digital scribes, last updated 30 January 2026). A scribe that generates "a diagnosis, differential diagnosis or treatment recommendation not explicitly stated by the healthcare practitioner" is a medical device and must be on the Australian Register of Therapeutic Goods.

Privacy law is the third leg: tell patients what is collected, where it is stored and who has access, and keep the privacy policy current. From 10 December 2026, APPs 1.7 to 1.9 (Privacy and Other Legislation Amendment Act 2024) require a privacy policy to describe certain decisions made, or substantially assisted, by a computer program that could significantly affect an individual. A scribe that only transcribes and summarises is unlikely to be one; a tool that suggests diagnoses, treatments or MBS items needs checking (see our AI privacy compliance post).

Recording consent law by state and territory

In five jurisdictions, a participant in a private conversation may record it only with the consent of every principal party: a person by or to whom words are spoken in the conversation. A carer, family member, interpreter or student who speaks is one, so they are asked too.

This is our reading of each Act as at 24 September 2026, and it agrees with Avant on the recording question. It adds that the NT (s 15), Queensland (s 45) and Victoria (s 11) each make it an offence to pass on a record without every party's consent unless an exception applies, so consent has a job to do there too. Confirm your position with your MDO: the lawful-interests and "not made to communicate" exceptions are untested for a tool sending a consultation to a vendor, so do not rely on them. Penalty units are stated as the Acts state them; we have not converted them to dollars.

Written or verbal? The bodies disagree

No Australian body of authority has settled whether AI scribe consent must be written, and the bodies that have spoken do not agree.

The practical answer is to choose with your MDO and record the choice. The template's cover page has fields for the MDO consulted, the date of the advice and the consent method adopted, so the decision is documented, not improvised. For psychologists the question is already answered: the APS requires written, tool-specific consent, and Part D is built for that.

One status note on F11: practices are still accredited against the 5th edition, and the Australian Commission on Safety and Quality in Health Care has not announced transition arrangements, so F11 is not assessable today. It applies only to practices that use AI.

How to customise this template

1. Approve the scribe under your AI Acceptable Use Policy first. This kit assumes the tool, plan and settings are already approved.
2. Get the vendor's contract and legal privacy page, and fill Part A from them, recording the page's date. Do not fill it from a brochure or product page.
3. Ask your MDO whether consent must be written, and record the answer and the date on the cover page.
4. If you are a psychology practice, use Part D, one form per tool, to meet the APS written, tool-specific requirement.
5. Give every clinician the Part C card, and agree the one-line note entries and whether to use ACRRM's optional label line.
6. Put the Part E wording into the registration form, booking terms, privacy policy and waiting room at the same time, so the messages match.
7. Brief reception on flagging records where a patient declines, so the scribe is not switched on for that patient again by accident.
8. Review whenever the vendor changes its terms or the tool changes, and at least annually. The cover page carries {{ }}Effective date{{effective_date}} and {{ }}Next review date{{next_review_date}} fields for this.

Related templates and tools

• AI Acceptable Use Policy: approves the scribe, the plan and the settings before this kit tells patients about it.
• AI Scribe Governance Pack: runs, assesses and monitors an approved scribe once patients have been told and asked, with the RACGP F11 evidence.
• Privacy Policy: the public APP 1 document that must say the practice uses an AI scribe.
• Patient Data Collection Notice: the general APP 5 notice at collection, which Part A sits beside.
• Informed Consent Procedures: consent to examination and treatment generally, including capacity and children.
• Privacy Impact Assessment: decides whether the scribe's data flows are acceptable at all, before it is switched on.
• Telehealth Policy: the Part C script card carries a telehealth note, and your telehealth setup needs the same consent discipline.
• AI privacy compliance for healthcare practices: what the 10 December 2026 privacy policy changes mean for AI tools.
• Informed consent documentation requirements: how consent is documented across Australian healthcare generally.
• RACGP 6th edition migration guide: what the 6th edition means for your practice, including F11.

Frequently asked questions

Do I need patient consent to use an AI scribe?

Yes. Three things require it: the professional bodies (RACGP F11.A, Ahpra, the TGA and the colleges), the listening devices Acts, and privacy law. Ahpra says to "make sure you obtain informed consent from your patient, and ideally note the patient's response in the health record" (Ahpra, page reviewed 22 August 2024): note "ideally note", not a mandatory written record.

Does AI scribe consent have to be in writing?

It depends on your profession and your MDO. The RACGP fact sheet says to ask your MDO, and accepts verbal consent recorded in the notes if written consent is not required. Avant accepts verbal confirmation documented in the records. The APS requires written, tool-specific consent from psychologists. Choose with your MDO and record the choice.

Do I need to ask for consent at every appointment?

Yes. The RACGP fact sheet says to obtain consent "at the beginning of each consultation". MIPS agrees: consent "needs to be obtained (and recorded) prior to each consultation", because in states where recording without consent is an offence, each consultation may be a separate offence. After a detailed first explanation, a short check is enough.

Is a sign in the waiting room enough?

No. MDA National is direct: "A sign in the waiting room or a note on the website or appointment booking platform will not protect you" (MDA National, current as at July 2026). The ACSQHC does list privacy notices with opt out options as one documentation method, so the bodies differ. The safe course is to ask in the consultation and record the answer.

What happens if a patient says no or withdraws consent?

The RACGP F11 actions: document the withdrawal, stop using AI in that patient's care unless clinically necessary and re-authorised, offer alternative care pathways where feasible, and explain the limitations respectfully. The ACSQHC adds: "stop the recording and delete any data and outputs." Care continues without the scribe.

Does a carer or interpreter in the room have to consent?

Yes, in NSW, WA, South Australia, Tasmania and the ACT, where every principal party to the conversation must consent before a participant records it. A carer, family member, interpreter or student who speaks is a principal party too. In the other jurisdictions, ask everyone anyway. Part B records who was present and whether each agreed.

Which states require everyone's consent to record a conversation?

NSW, WA, South Australia, Tasmania and the ACT require each principal party's consent before a participant records a private conversation. In the NT, Queensland and Victoria a participant may record, but each of those jurisdictions separately makes it an offence to pass on the record without every party's consent unless an exception applies. Confirm your position with your MDO.

Does this template work for psychologists and allied health?

Yes. Part D is a written consent form for the APS requirement that psychologists obtain written, tool-specific consent, one form per tool, with separate lines for offshore processing and vendor product improvement. The Australian Physiotherapy Association expects patients to be "clearly informed of the nature, purpose, and limitations of the AI system" and to consent "without coercion" (APA, Use of artificial intelligence in physiotherapy, August 2026).