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Registered Provider Application Form Antenatal Shared Care Program Personal and professional details: SURNAME: Given Name: Name of Surgery: Qualifications: Postcode AH PRA Number Telephone: VR: YES/NO

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What is registered provider application form?

The registered provider application form is a document that must be completed by providers who wish to be registered in a specific program.

Who is required to file registered provider application form?

Providers who want to be registered in a specific program are required to file the registered provider application form.

How to fill out registered provider application form?

The registered provider application form can be completed online or in paper form by providing all the required information and supporting documents.

What is the purpose of registered provider application form?

The purpose of the registered provider application form is to collect necessary information from providers who want to participate in a specific program.

What information must be reported on registered provider application form?

Providers must report information such as personal details, qualifications, experience, and any relevant documents as required by the specific program.

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