Positron emission tomography - statutory declaration form (HW064)
Use this form to list the provider number and Location Specific Practice Number (LSPN) of the diagnostic imaging practice applying to perform PET services.
Download and complete the Positron emission tomography - statutory declaration.
PET is the Positron Emission Tomography.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 4 February 2020