Medical-Objects Online Forms

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Add Doctor

Download manual copy of the form

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Alternatively you can download a copy of the offline form from the link in the header.

Online Application
Add Doctor

When you reach the end of the form please take note of the instructions detailing how to submit your application.

If you get stuck or have any questions please don't hesitate to contact us.

Practice Details

Practice Name HPI-O (Organisation Identifier)

Street

City

State Postcode

Phone Number Fax Number Practice Manager's Name

Confirm Email

Mailing Address

Use Practice Details

Mailing Street/PO Box

Mailing City

Mailing State Mailing Postcode

Installation Details

Will the new doctors be sending?

Receive Only

Sending Specialist Letters/Reports or Allied Health Letters/Reports

Providers Details

Title

First Name

Middle Name

Last Name

Job Title

Job Class

Medicare Provider Number

HPI-I

Provider Location

You must first remove all added providers before uploading documents.

Providers

Name	Job Title	Job Class	Medicare Provider	HPI-I	Remove
Default Location

Provider numbers are location specific by Medicare. If you move practices your provider number will remain at the assigned location for outstanding results for 12 months. If you wish to change the location, we will require an agreed notice from you and the practice before relocating the provider number.

Please finish adding your provider or clear the provider details.

Upload Provider Details

Alternatively you may choose to upload an Excel spreadsheet that lists your providers. This can be done instead of manually inputting the providers details.

Please use the provided Excel template which will allow you to correctly structure your list of providers.

Download template

Choose a file or drag it here.

No files selected

Error, files must be of the following type: xls or xlsx.

Error, file limit is 1 file, no bigger than 2MB.

Uploaded file must be of the following type: xls or xlsx.

Authorisation

Full Name Job Title

Authorisation Agreement
I declare that I am authorised to submit this form

If you are not the authorised person, please leave the option above unchecked and print the form at the end for signing by the authorised person.

Terms and Conditions

Medical-Objects agrees to adhere to all Privacy Act 1988 (Commonwealth) (“the Act”) and the Australian Privacy Principles (“APPs”) and any other applicable privacy laws that govern how private sector Health Service providers handle your personal information (inclusive of sensitive information and Health Information). Please read the Medical-Objects Privacy Policy located www.medicalobjects.com/privacy.

I understand and accept this agreement with the knowledge that Medical-Objects Pty Ltd will be using the personal information provided by me on this form in order to supply Medical-Objects Health Software Products and Services and not for unsolicited communication or marketing. I understand and accept that Medical-Objects products, services and personal information will be used by us for managing healthcare information, services and communications only. I understand that it is our responsibility to provide adequate security to protect personal and sensitive information located on our premises.

I understand that software support covers Medical-Objects products and services only. I agree to the Medical-Objects terms and conditions found at www.medicalobjects.com/MedicalObjectsSLA.pdf. I understand the Medical-Objects Refund Policy found at www.medicalobjects.com/refund-policy. I agree to notify Medical-Objects Pty Ltd of any problems or errors and to provide feedback directly.

Terms and Conditions Agreement
I agree with the Terms and Conditions

Finish

Additional Notes Any additional notes you'd like to submit.

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