Nurse Practitioner owned or led practices and Allied Health Surgical Mask and goggles Request.

Introduction, please read closely.

Nurse Practitioner owned or led primary care practices and Allied Health professionals are now eligible for limited access to Level 2 Surgical masks and goggles for the use of their staff when there is no available commercial supply and they are working in higher-risk clinical areas, and with higher risk vulnerable patients.
In this instance, it is essential that the allied health professional use the masks provided in line with the advice for appropriate use of PPE, available at health.gov.au. If a practitioner is unwell they should not see patients.

Supply is strictly limited, so South Eastern Melbourne PHN will take into account the profession and patient type seen, and will allocate accordingly.

South Eastern Melbourne PHN can only supply to practices within our catchment. If needed please check the PHN Locator online.

Please make sure someone is at the delivery address to receive the masks, or consider an address that will be able to be confidently delivered to (e.g. a neighbouring business).

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* 1. Organisation name

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* 2. Address Street and number. Line 1 (30 characters max)

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* 3. Address Street and number. Line 2 (30 characters max)

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* 4. Address Suburb

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* 5. Address Postcode

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* 6. Select your LGA (council area)

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* 7. Requesting Name

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* 8. Phone number

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* 9. Email

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* 10. Position

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* 11. Type of Nurse Practitioner and/or Allied Health Profession/s working at this address

Profession

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* 12. What types of patients and procedures are you working with that require surgical masks and / or goggles to be worn by the Allied Health professional?

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* 13. Please tick which PPE you are requesting

Surgical masks

Goggles

If requesting goggles, please request an amount up to 20.

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* 14. Please tick here to confirm you are seeing patients that require face to face intervention, and have been unable to commercially secure masks for you/r staff.

YES, we are seeing patients that require face to face intervention, and have been unable to commercially secure masks for our staff.

NO, we do not see patients that require face to face intervention, and/or have been able to commercially secure masks for our staff.