Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019)

Use this form to apply for an initial or subsequent Medicare provider number or a prescriber number, or both.

Download and complete the Application for a Medicare provider number and, or prescriber number for a medical practitioner form.

Your application and supporting documentation should be sent to Medicare Australia prior to your proposed commencement date.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 10 December 2021