NSBD - PACS Application

Practice name *

Is this a Hospital *

YesNo

Work street address *

Suburb *

State *

Postcode *

PRP Currently only operates in NSW. As your location is interstate, please complete this form to request access to a specific patient.

If you believe you will require ongoing access to PRP patient data and want to proceed to creating an account, tick this box to continue *

Work phone *

Further Information

First Name *

Last Name *

Email for Confirmation & Password Resets *

Provider No

AHPRA registration number *eg MED000XXXXXXX, CHI000XXXXXXX, PH000XXXXXXX

By ticking this box you are agreeing to the following terms and conditions:

To comply with the confidentiality and external access terms and conditions
My data being collected and stored as per PRP's privacy policy
To access the PRP Portal/InteleViewer™ only in the course of your work as a treating health professional and not for any other purpose
To keep the contents of PRP PACS confidential and not disclose the contents of PRP PACS to any person

*

Date Stamp