Forms

Form Description
Notifiable Disease Fax Form used by medical professionals to inform PHS of a notifiable disease via fax.
VTA Application Application for a Permit for the Use of Vertebrate Toxic Agent(s) Hazardous Substances and New Organisms Act 1996 (HSNO)
Authorisation As a Vaccinator First Application to Medical Offer of Health for Authorisation as an Independent Vaccinator
Reauthorisation as a vaccinator Application to Medical Officer of Health for
Re - Authorisation as an Independent Vaccinator
Local Influenza Programme 2017 Approval Letter

Please indicate your willingness to deliver a local influenza programme to the well population, by signing and returning this letter, including the name of the clinician with overall responsibily for this programme within your practice and those who will be administering the vaccines

2017 Local Programme Application Form

You will be required to submit an Annual (2017) Application for all other Local Programmes e.g. non-funded Hepatitis B, Varicella, Tdap to substitute for 45 and 65 boosters, or as cocooning for grandparents.

Please complete the application form and return to your local Immunisation Coordinator.