General practice PPE request The Department of Health distribution of PPE guidelines are provided to ensure consistent and transparent management of the limited supply from the National Medical Stockpile. EMPHN is distributing PPE as per the Department of Health guidelines:Distribution of PPE through PHNs: Tranche 4 - 5 August 2020Addendum to Tranche 4 guidelines - distribution of gowns - 17 July 2020Addendum to Tranche 4 guidelines - distribution of eye protection - 12 August 2020Guidance on the use of masks is available from DHHS.Please note: EMPHN is required to submit data to the Department of Health each week on the distribution of PPE to general practices.Allocation will be based on a fortnightly supply, please submit your request no more than once a fortnight. Only PPE that you are unable to source commercially can be requested. Please note allow 5 business days for delivery. Question Title * 1. Practice name Question Title * 2. Street address - Line 1 (30 characters maximum) Question Title * 3. Street address - Line 2 (only if required and 30 characters maximum) Question Title * 4. Suburb Question Title * 5. Postcode Question Title * 6. Contact name Question Title * 7. Contact phone number Question Title * 8. Email address Question Title * 9. How many GPs work in your practice? Solo 2-5 6-10 11-15 16+ Question Title * 10. How many staff in total work in your practice? Please include all clinical staff (GPs, nurses, allied health) and all non-clinical staff. Question Title * 11. Do you have GPs that are also attending aged care facilities? Yes No Comment Question Title * 12. What PPE is your practice requesting?Surgical masks Level 2/3 - For limited contact, of short duration, in a controlled environment with a person who is suspected or confirmed to have COVID-19Goggles are reusable and are readily available (cleaning guidelines must be adhered to) Surgical masks - Level 2/3 P2/N95 masks Gowns - Level 2 Goggles Question Title * 13. Current PPE stock levels in your practice? Surgical masks - Level 2 / 3 P2/N95 masks Gowns Question Title * 14. Is your practice currently testing for COVID-19? Yes No Question Title * 15. I am authorised to submit this request on behalf of my organisation and I am unable to source a commercial supply of the PPE requested. I agree If we have questions regarding your request we will contact you, otherwise, please ask your reception staff to keep an eye out for your delivery. Please allow up to 5 business days for your request to be processed. For further enquiries please email: practicesupport@emphn.org.au. Done