Healthcare Identifiers Service Application to request a pseudonym Individual Healthcare Identifier record form (MS005)

Use this form if you want to create a pseudonym Individual Healthcare Identifier (IHI) if you consider yourself vulnerable or at risk.

Download and complete the Healthcare Identifiers Service Application to request a pseudonym Individual Healthcare Identifier record form.

You must already have a verified Individual Healthcare Identifier (IHI) record to be eligible for a pseudonym IHI.

You cannot claim Medicare or pharmaceutical benefits using a pseudonym IHI.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

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 use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 16 April 2020