PRACTICE NUMBER APPLICATION - NAMAF | Home

1 Conditions: Submission of APPLICATION form does not provide automatic access to a PRACTICE NUMBER . The process of granting a healthcare provider with a PRACTICE NUMBER is subject to the completeness of this document. No 8. Newton Street Failure to complete the form in full and submit all supporting Windhoek, Namibia documentation may result the processing of your APPLICATION P. O. Box 11974. being delayed. NAMAF will not accept any responsibility for Klein Windhoek incomplete submissions. Tel: 264 61 257211/2. Should a PRACTICE NUMBER be granted / renewed it will be done Fax: 264 61 257213. on the assumption that all information contained herein is of a Mail: truthful nature and therefore correct. Website: Date of APPLICATION : . Name in which PRACTICE NUMBER will be allocated (Prof.)

2 , Dr., Sr., Mr., Mrs., Ms., Name of Facility, etc.): .. PRACTICE NUMBER APPLICATION .. Trading Name: .. Scope of PRACTICE : .. KINDLY COMPLETE THIS FORM IN PEN, IN A CLEAR AND LEGIBLE PRINT. ALL PHOTOCOPIES OF DOCUMENTS MUST BE CERTIFIED. FAXED OR E-MAILED applications WILL NOT BE CONSIDERED. applications WILL NOT BE PROCESSED UNLESS ALL REQUIRED. DOCUMENTS ARE ATTACHED. NO CASH PAYMENT WILL BE ACCEPTED. ONLY CROSSED CHEQUES. ISSUED TO NAMAF OR PROOF OF ELECTRONIC FUNDS TRANSFER OR. PROOF OF DIRECT BANK DEPOSITS WILL BE ACCEPTED AS VALID PROOF. OF PAYMENT. The following information is required for the allocation of a NAMAF PRACTICE NUMBER : A. ALL APPLICANTS: 1. Certified copy of valid professional registration with the relevant Health Professions Council of Namibia. 2. Certified copy of Namibian Identity Document / Namibian Passport /.

3 Namibian Work Permit / Namibian Permanent Resident Permit. 3. Certified copy of Marriage Certificate. (If name on certificates differs with the names provided on the professional registration). 4. Certified copy of valid Health Registration Certificate, as issued by the Ministry of Health and Social Services. (All healthcare practitioners must register for a License or Health Registration Certificate with the Ministry of Health and Social Services, irrespective of whether or not the practitioner has rooms that need to be inspected.). Inquiries in this regard must be directed to the Health Facility Regulation Directorate of the Ministry of Health & Social Services. 5. Certified copies of valid dispensing license issued by the Medicines Regulatory Control Council should be provided with the PRACTICE NUMBER APPLICATION , where applicable.

4 2. B. COMMUNITY or HOSPITAL PHARMACY: 1. Certified copies of appointment certificate of Responsible Pharmacist;. 2. Certified copies of Community or Hospital Pharmacy Registration issued by Pharmacy Council of Namibia; and 3. Certified copies of Health registration certificate issued by MoHSS. C. GROUP OR MULTI-DISCIPLINARY practices : In group or multi-disciplinary practices , all healthcare practitioners must each apply separately for an individual PRACTICE NUMBER and then a joint APPLICATION must be submitted for the group or multi-disciplinary PRACTICE NUMBER . D. HEALTHCARE PRACTITIONERS IN THE EMPLOYMENT OF GOVERNMENT: NAMAF does not allocate PRACTICE numbers to Government employed healthcare practitioners unless the following documentation are provided: 1. Certified copy of Limited Private PRACTICE permission from the Permanent Secretary of the Ministry where the healthcare practitioner is employed.

5 OR. 2. If the practitioner has resigned from Government employment, a copy of the letter from the relevant Ministry confirming such resignation. E. HOSPITALS: 1. Certified copy of valid Health Registration Certificate in terms of Section 23 of the Hospitals & Health Facilities Act, 1994 (Act 36 of 1994), as allocated by the Ministry of Health and Social Services. 2. Should the hospital have an X-ray, Pathology and Pharmacy, a separate PRACTICE NUMBER APPLICATION must be submitted for each of these departments, ( these services cannot be claimed under the Hospital PRACTICE NUMBER ). 3. The practicing healthcare practitioner in these departments must provide certified copies of: i. their Namibian professional Registration Certificates, ii. License/Registration Certificate as allocated by MOHSS, 3.

6 Iii. Namibian ID/Passport or iv. Work Permit, and v. marriage certificate if the names on the APPLICATION is different from that on the healthcare practitioners proof of professional registration. F. HEALTH FACILITIES: 1. Certified copy of valid Health Registration Certificate issued in terms of Section 23 of the Hospitals & Health Facilities Act, 1994 (Act 36 of 1994), as allocated by the Ministry of Health and Social Services. 2. Should the hospital have an X-ray, Pathology and Pharmacy, a separate PRACTICE NUMBER APPLICATION must be submitted for each of these departments, ( these services cannot be claimed under the Hospital PRACTICE NUMBER ). 3. The practicing healthcare practitioners in these departments must provide certified copies of: i. Professional Registration with relevant HPCNA, ii.

7 License/Registration certificate issued by MOHSS, iii. Namibian ID/Passport iv. Work Permit, and v. marriage certificate if the names on the APPLICATION are different from that on the practitioner's proof of professional registration. G. AMBULANCES: 1. Certified copies of identity documents of all ambulance personnel; and/or 2. Certified copies of valid passport/s of all ambulance personnel;. 3. Certified copies of valid work permit or permanent residence in case of ambulance personnel that are not Namibian citizens;. 4. Certified copies of proof of professional registration of all ambulance personnel;. 5. Updated NUMBER of vehicles to be used as ambulances and certified copies of vehicle road worthy;. 6. Certified copies of driver's licenses of all ambulance service staff registered with the Allied Health Professions Council of Namibia.

8 7. Certified copies of proof of defensive driver training by an accredited institution of all vehicle operators;. 8. Certified copy of Health Registration Certificate issued by MoHSS with an indication of the allowed scope (Basic, Intermediate or Advanced Life Support);. 9. Employment contracts/confirmation for each registered staff member;. 4. H. POSTAL ADDRESS OF PRACTICE : (This is the address that all correspondence and/or invoices from NAMAF and the Funds will be posted to. Thus, you should ensure that it is the correct address and furthermore that you keep NAMAF informed of any change in address. If you fail to do this, then you will not receive NAMAF 's Annual Fee Invoices' for the renewal of your PRACTICE NUMBER annually, which means that your NUMBER could be deleted from the PCNS.)

9 POSTAL. ADDRESS: SUBURB: TOWN: COUNTRY: POSTAL CODE: I. PHYSICAL ADDRESS OF PRACTICE : NUMBER OF. OFFICE/. HOUSE/. FLAT, ETC: STREET NAME: SUBURB: TOWN: COUNTRY: J. STARTING DATE OF PRACTICE : 5. K. IF JOINING AN EXISTING GROUP OR MULTI-DISCIPLINARY PRACTICE , PROVIDE PRACTICE NUMBER OF SUCH GROUP OR MULTI-DISCIPLINARY. PRACTICE : L. IS THIS A SOLUS OR GROUP OR MULTI-DISCIPLINARY PRACTICE ? SOLUS. GROUP OR. MULTI- DISCIPLINARY. NOTE FOR GROUP OR MULTI-DISCIPLINARY PRACTICE : (a) For a Group or Multi-Disciplinary PRACTICE , all partners' professional Registration Certificates, ID's, etc, must be attached;. And;. (b) If these partners already possess a personal PRACTICE NUMBER , such NUMBER must be indicated, per partner on this APPLICATION ;. And;. (c) If a member of the group or multi-disciplinary PRACTICE does not possess a personal PRACTICE NUMBER , he/she must apply separate from the group or multi-disciplinary PRACTICE to get such a personal NUMBER .

10 6. INDIVIDUAL PRACTICE NUMBERS OF EXISTING MEMBERS: 1.. 2 .. 3 .. 4 .. NOTE: Each individual member will use his/her personal PRACTICE NUMBER when submitting claims to the Medical Aid Funds in respect with patients treated by him/her for identification of the treating Practitioner in respect of all claim submitted to the Funds. Such claims will however be remitted under the banking details of the group or multi-disciplinary PRACTICE NUMBER . L. IF YOU HAVE AN EXISTING PRACTICE NUMBER PLEASE PROVIDE THIS. NUMBER . If you had a PRACTICE NUMBER previously whether it is a SADC or NAMAF NUMBER , this must be indicated. NAMIBIAN PRACTICE . NUMBER : SADC PRACTICE . NUMBER : DATE OF CLOSURE OF. PRACTICE : (If you have left a partnership PRACTICE kindly indicates the partnership's PRACTICE NUMBER . 7.)