On the 30 April 2020, the Australia Government Department of Health issued guidance on the supply of masks from the National Medical Stockpile for general practice (including Aboriginal Community Controlled Health Services), community pharmacy, and allied health through the Primary Health Networks (PHN). 
 
PHNs have been asked to consider a number of factors relating to allied health practice when distributing masks. To assist with this process, please complete the survey below. Once you have submitted the survey, your request will be assessed and if eligible, one box of 50 surgical masks will be sent to you within one week.  

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* 1. Organisation Name

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* 2. Service type/s:
Please indicate the professional services that your organisation provides - e.g. Psychology; Physiotherapy; Dietetics; Podiatry; Occupational Therapy; Speech Therapy; Exercise Physiology; Social Work; Counselling; etc)

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* 3. Contact Information

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* 4. Have all commercial avenues for surgical masks been exhausted?
Please indicate if you have had multiple attempts with different suppliers to provide surgical masks for your service, but have been unsuccessful in being able to make a purchase due to low or inadequate stock?

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* 5. Does your service require you to have close contact with patients who are potentially unwell with respiratory symptoms?

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* 6. Patients with high vulnerability to COVID-19: 
Please indicate if you treat patients who are highly vulnerable including those who are immuno-compromised, elderly or have a disability?

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* 7. Face-to-face care required: 
Please indicate if your treatment/care can only be delivered face-to-face and there is no other option for an alternative method of service delivery to reduce the chance of transmission such as telehealth? 

 
Thank you for completing the survey. You will hear from Brisbane North PHN about the status of your request within 48 hours. For further enquiries, please email covid19@brisbanenorthphn.org.au.

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