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Application Form for Hepatitis B s100 Prescribing Rights for recognition of prior experience

About you

Please note that this application will require you to provide documentary evidence for ONE of the following criteria.
1. Substantial experience as a practitioner with responsibility for the management of patients with hepatitis B.
2. Completion of at least one year full time (or equivalent) supervised advanced training in a relevant area
3. Completion of 40 half-day sessions (or their equivalent) in a specialised HBV treatment unit/Liver clinic with access to a senior on-site HBV physician or practitioner and other direct supervision or peer review of case management.

If you have any questions please contact HBVPrescriber@ashm.org.au
1.First name(Required.)
2.Last name(Required.)
3.Email (personal)(Required.)
4.Mobile (personal)(Required.)
5.Languages other than English that you speak with your patients
6.Position(Required.)
7.Main service setting
8.Which states/territories do you wish to prescribe in?

Please note: Only select the states/territories which you currently practice or participate in locum work. ASHM will not pursue the additional state/territory accreditation until the home state is approved.(Required.)