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 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: 10 February 2020
This information was printed 5 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/hw012. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.