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Consent to release an electronic Aged Care Client Record form (AC010)

Use this form to prove that a care recipient or nominee has consented that an aged care service or Aged Care Assessment Team can request a copy of their electronic Aged Care Client Record.

  1. Health professionals
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Application for a PKI site certificate form (HW001)

Use this form to apply for a Public Key Infrastructure (PKI) Site Certificate.

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Simplified Billing or ECLIPSE adjustment claim form (HW023)

Use this form to adjust a previously processed claim which needs to be amended with new or altered information.

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Ankylosing spondylitis continuing PBS authority application form (PB074)

Use this form to apply for continuing PBS subsidised treatment with a biological agent for adult patients with ankylosing spondylitis.

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Chronic myeloid leukaemia chronic phase - first line initial PBS authority application form (PB083)

Use this form to apply for initial PBS subsidised dasatinib or nilotinib for first line treatment of chronic phase of chronic myeloid leukaemia.

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Provider registration for Electronic Funds Transfer payments form (HW029)

Use this form to nominate bank account details you would like us to record for 1 or more of your current provider numbers.

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Register for or amend a Location Specific Practice Number form (HW061)

Use this form to register for or amend your LSPN for diagnostic imaging premises or base for diagnostic imaging equipment.

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Application for recognition as a specialist or consultant physician form (HW077)

Use this form to apply for recognition as a specialist or consultant physician so you can provide services to private patients that attract Medicare Benefits at the specialist or consultant physician rates.

  1. Health professionals
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General Practitioner Aged Care Access Incentive Payment banking details form (IP011)

Use this form to tell us about new or amended bank account details for the Practice Incentives Program (PIP) Service Incentive Payments.

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Provider Directory Data authorised recipient data release application or renewal form (MO003)

Use this form to seek authorisation for a contact person to access to data and receive correspondence in the Provider Directory System.

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Page last updated: 10 December 2021