Positron Emission Tomography - Statutory Declaration form (HW064)

To be eligible to perform Positron Emission Tomography (PET) services, a provider must complete a statutory declaration that lists the provider number and Location Specific Practice Number (LSPN) of the diagnostic imaging practice.

Page last updated: 8 June 2016

This information was printed Thursday 29 September 2016 from humanservices.gov.au/health-professionals/forms/hw064 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.