Registration for a Location Specific Practice Number form (HW061)

Use this form to register for a diagnostic imaging premises or base for diagnostic imaging equipment.

A separate form is required for each practice location and must be signed by a proprietor or authorised representative.

 
This form can be uploaded through HPOS. Read more about form upload in HPOS.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
This information was printed Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/hw061 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 10 April 2019