Healthcare Identifiers Service Application to request a pseudonym Individual Healthcare Identifier record form (MS005)

Use this form if you want to create a pseudonym Individual Healthcare Identifier (IHI) if you consider yourself vulnerable or at risk.

You must already have a verified Individual Healthcare Identifier (IHI) record to be eligible for a pseudonym IHI.

You cannot claim Medicare or pharmaceutical benefits using a pseudonym IHI.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

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Page last updated: 25 September 2017