Application for General Practitioner Credentialing

Requested privileges do not include admitting rights to University Hospital Geelong.

On receipt of this application you will receive an invitation to submit your profile for credentialing for the privilege or specialty requested.

If you have any questions, please call 03 4215 0559.

AHPRA registration number:*

Title:*

Name:*

Contact number:*

Email:*

Privilege/Speciality requested:* Aged Care Antenatal Shared Care

GP Information (only complete if requesting access to Antenatal Shared Care)

Date of attainment of Diploma RANZCOG or equivalent:

Date of attainment in CSCT in Women’s Health:

Relevant post graduate qualifications and experience (please detail):

Verification

Last Modified: Thursday, 21 November 2019

Health Practitioner Credentialing