Forms

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
2019 Influenza Local Programme Endorsement At the time of your next Authorisation Application; your Certificate will include Influenza Vaccines to well Population ie unfunded. This Letter of Endorsement will cover your practice in the meantime.
2019 Local Programme Application Form

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