HI Service - My Health Record system - application to register a contracted service provider organisation record form (HW012)

Use this form to register a Contracted Service Provider with the Healthcare Identifiers Service or the My Health Record system.

You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

Download and complete the HI Service - My Health Record system - application to register a contracted service provider organisation record form.

You can also request a National Authentication Service for Health (NASH) Public Key Infrastructure (PKI) Certificate for your organisation.

You must read and agree to the terms and conditions of use when applying for a NASH PKI certificate. These are on pages 10 and 11 of this form.

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Page last updated: 6 December 2024.
QC 21761