Central and North West Queensland Medicare Local After Hours Reporting

Practice Information

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* 1. Full name of person completing report

First Name:

Surname:

Position:

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* 2. Practice Name

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* 3. Registered Business Name

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* 4. Postal Address

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* 5. Email Address

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* 6. Practice reception number

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* 7. Practice Fax Number

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* 8. Number of GP's involved in After Hours

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* 9. Medicare Australia PIP Standardised Whole Patient Equivalent (SWPE) number

August

November

February

May