HI Service - application to amend details of a contracted service provider organisation record form (HW043)

Use this form to add or amend the record of a Contracted Service Provider (CSP) organisation within the Healtchare Identifiers (HI) Service.

You must ensure that the amendments made to a CSP organisation details do not deem the CSP organisation ineligible for ongoing use of a CSP registration number under the Healthcare Identifiers Act 2010.

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 February 2019

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