Transcription of application for online access - HPV Register
1 The National HPV Vaccination Program Register (NHVPR) is fully funded by the Australian Government (Department of Health and Ageing) and operated by VCS form is to be completed by General Practitioners who wish to obtain access to the HPV Register s online facilities to: Submit notifications of HPV vaccine doses given to patients Search the HPV Register database to view a patient s HPV vaccination history View HPV vaccination Overdue Dose reportsNHVPR-F-13 v6 February 2013application for online accessGeneral practitioner DetailsMedicare Provider Number: Title:First name:Middle name:Surname:Phone number: ( )Email:note: An email address must be provided for online access to be granted. This email address will be used to send you your password for online access and Register updates. A letter containing your user name, instructions for logging in, and a Quick Reference Guide will be posted to Details (please note address details will be verified through Medicare)Business name:Practice name:Street:Suburb:State:Postcode:contac t person for practiceFirst name:Surname:Phone number: ( )Fax number: ( )General practitioner s siGnatUresignature: Date: / /to return this form faX: (03) 8360 8699 or Mail: reply paid 725, sunshine Vic 3020for assistance or enquiries please call 1800 478 734 (1800 HpV reG) or visit
