Provider Directory Data authorised recipient data release application or renewal form (MO003)

Use this form to seek authorisation for a contact person to access to data and receive correspondence in the Provider Directory System.

This form must be signed by the Chief Executive Officer or the Public Officer of an incorporated body, for example, Health Sector Entity Representative.

 
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/mo003 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: 19 September 2018