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Central and North West Queensland Medicare Local After Hours Reporting
Practice Information
*
1.
Full name of person completing report
(Required.)
First Name:
Surname:
Position:
*
2.
Practice Name
(Required.)
*
3.
Registered Business Name
(Required.)
*
4.
Postal Address
(Required.)
*
5.
Email Address
(Required.)
*
6.
Practice reception number
(Required.)
7.
Practice Fax Number
*
8.
Number of GP's involved in After Hours
(Required.)
*
9.
Medicare Australia PIP Standardised Whole Patient Equivalent (SWPE) number
(Required.)
August
November
February
May
