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.

Your application and supporting documentation should be sent to Medicare Australia prior to your proposed commencement date.

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: 13 March 2019

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