Update GP or Practice details with the MNCLHD

Have you recently had a GP join or leave the Practice or any General Practice changes?

It’s crucial that MNCLHD has the correct GP detail information to ensure all electronic information coming from hospital is delivered correctly.

Please use the form to update our hospital system information that the MNCLHD holds for your Practice and General Practitioners.

Person submitting the form
Name*
First Last
Email*
Your role*
- Practice Manager
- Other
My role is*
GP Information
Number of Doctors
Select the number of Doctors to add or modify. Maximum of 4 doctors per submission.
Doctor #1 Details
Reason for Dr #1 submission*
Dr #1 Start Date*
DD slash MM slash YYYY
Dr #1 End Date*
DD slash MM slash YYYY
Dr #1's Full Name (per AHPRA registration)
Dr #1's Registration Number
Dr #1's Practitioner Type
Dr #1's Provider number
Dr #1's HPI-I
Doctor #2 Details
Reason for Dr #2 submission*
Dr #2 Start Date*
DD slash MM slash YYYY
Dr #2 End Date*
DD slash MM slash YYYY
Dr #2's Full Name (per AHPRA registration)
Dr #2's Registration Number
Dr #2's Practitioner Type
Dr #2's Provider number
Dr #2's HPI-I
Doctor #3 Details
Reason for Dr #3 submission*
Dr #3 Start Date*
DD slash MM slash YYYY
Dr #3 End Date*
DD slash MM slash YYYY
Dr #3's Full Name (per AHPRA registration)
Dr #3's Registration Number
Dr #3's Practitioner Type
Dr #3's Provider number
Dr #3's HPI-I
Doctor #4 Details
Reason for Dr #4 submission*
Dr #4 Start Date*
DD slash MM slash YYYY
Dr #4 End Date*
DD slash MM slash YYYY
Dr #4's Full Name (per AHPRA registration)
Dr #4's Registration Number
Dr #4's Practitioner Type
Dr #4's Provider number
Dr #4's HPI-I
Practice Details
Organisation*
Practice Name
Practice address
Street Address Address Line 2 Suburb Postcode
Practice Phone Number
Practice Email
Practice organisation number (HPI-O)
Practice’s IT contact name
Practice IT Provider Company name (if different from GP practice)
IT Provider contact email
Secure Messaging Broker*
- Argus
- Medical object
- Healthlink
- Other
My Secure Messaging Broker is*
GP Software
Practice Manager’s Name
Name*
First Last
Practice Manager’s email
Practice Manager’s phone
Name
This field is for validation purposes and should be left unchanged.

Update GP or Practice details with the MNCLHD

Person submitting the form

GP Information

Doctor #1 Details

Doctor #2 Details

Doctor #3 Details

Doctor #4 Details

Practice Details

Practice Manager’s Name