HI Service - application to amend details of a contracted service provider organisation record form (HW043)

Use this form to add or amend the record of a Contracted Service Provider (CSP) organisation within the Healthcare Identifiers (HI) Service.

Download and complete the HI Service - application to amend details of a contracted service provider organisation record form.

You must ensure that the amendments made to a CSP organisation details do not deem the CSP organisation ineligible for ongoing use of a CSP registration number under the Healthcare Identifiers Act 2010.

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