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* 1. First name

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* 2. Last name

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* 3. Email address

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* 4. Mobile number

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* 5. What is your profession?

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* 6. RACGP ID number

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* 7. ACRRM number

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* 8. Primary workplace name

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* 9. Primary workplace suburb/town

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* 10. Is your work location classified as:

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* 11. Will you be available to attend the mandatory audit group meeting #1 to be held on Thursday, 22nd Feb from 6.30-7.30pm ACDT via Zoom

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* 12. Will you be available to attend the mandatory audit group meeting #2 to be held on Thursday, 30th May from 6.30-7.30pm ACDT via Zoom

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* 13. Will you be able to identify at least 2 patients with who have been injured in the course of their work and have an active work injury claim or work injury claim pending determination, to review as part of the audit activity?

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* 14. What would you like to gain from participating in the Work Injuries Clinical Audit?

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* 15. How did you hear about the Work Injuries Clinical Audit?

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* 16. Would you like to subscribe to SAPMEA's fortnightly e-newsletter?

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