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.

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 contact us. We can help you access, complete and submit them.

Page last updated: 15 May 2020