Thank you for your interest in our Project: Beyond the C- Hepatitis C Elimination in your practice.

To determine whether you are eligible to join the Project, please complete the survey below. All responses will be assessed by our team and we will be in touch with you shortly.

If you have any questions please email: 
olivia.dawson@ashm.org.au

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* 1. Personal details

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* 2. Position

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* 3. Practice details

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* 4. Is your practice currently accredited against the Royal Australian College of General Practitioners Standards for general practices?

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* 5. Are you currently enrolled in a Department of Health Practice Incentive Program (PIP) Quality Improvement (QI) initiative?

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* 7. Do you consent to ASHM contacting your local PHN to provide information about the Project?

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* 8. Which Medical Software System does your practice use?

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* 9. Do you have access to data extraction tools? 

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* 10. If yes, please name which data extraction tool

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* 11. Have you, or your Practice representative, read and signed the Terms of Reference?

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* 12. Upload signed Terms of Reference, or email to olivia.dawson@ashm.org.au

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