Forms

Licensing forms are currently being reviewed.  Please contact the Regulation and Licensing unit at  hselicensing@dhhs.tas.gov.au if you require any of the following forms and they will be provided to you.

 Form No.

Form Title

Use

1

Application for Licence to Operate a Private Hospital or Day Procedure Centre

Application - Licence

1A

Application for a Licence to Operate a Private Hospital or Day Procedure Centre

(Process Information)

 

1B

Licence Application Submission Checklist

(Process Information)

 

2

Application for Transfer of Licence for a Private Hospital or Day Procedure Centre

Application - Transfer

2A

Transfer of Licence

(Process Information)

 

2B

Transfer of Licence Application Submission Checklist

(Process Information)

 

3

Application for Approval to Alter or Extend a Private Hospital or Day Procedure Centre

Application - Alteration

4

Fitness and Probity Check

Application - Consent

5

Temporary Licence Certificate

DHHS Licence

6A

Schedule of Conditions – Day Procedure Centre

DHHS Licence

6B

Schedule of Conditions – Private Hospital

DHHS Licence

7

Public Notice

DHHS Notice

8

Notice of Repairs, Maintenance or Improvements

DHHS Notice

9

Notice of Intention to Alter Licence Conditions

DHHS Notice

10

Notice of Request for Additional Application Information

DHHS Notice

11

Notice of Amendment of Licence Conditions

DHHS Notice

12

Notice of Intention to Cancel a Licence

DHHS Notice

13

Notice of Refusal to Grant a Licence

DHHS Notice

14

Health Service Establishment Licence Certificate

DHHS Licence

14A

Licence in Principle

DHHS Licence

15

Certificate of Authority to Inspect Premises

DHHS Notice

16

Reporting Requirements Notice

DHHS Notice

17

Health Service Establishment Annual Licence Fee Certificate

DHHS Notice

18

Incident Form
Reporting Advisory Note

HSE Reporting

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Record of Conviction Consent Form

Application – Consent

Forms for licensing are currently being reviewed. If you would like a copy of the above forms, please contact hselicensing@dhhs.tas.gov.au and a hard copy will be provided to you.