Application to request a NASH PKI Certificate for Individual Healthcare Providers form (HW022)

Use this form to request a NASH PKI Certificate to interact with the My Health Record system Provider Portal if you are an Individual Healthcare Provider.

You should be registered with the Healthcare Identifiers (HI) Service to use this form.

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

Page last updated: 25 September 2017