What information do I need to provide with my application?
For new licence applications (including applications to transfer, alter or extend), the following information is to be provided. Please note the Secretary may also request further information from applicants to assist in the assessment of the licence application. An application may be refused where an applicant fails to provide the required information.
Organisational Structure and Administration
- If the applicant is a company or charitable organisation, a certificate of incorporation (or Act of Parliament creating the organisation), and company extract listing the directors' details (this should include contain the full name/s, title, date and town/city/country of birth, current address and occupation of Directors/Principals of the company);
- If the applicant is a trustee, a copy of the trust deed;
- If the applicant is an individual, full name, title and date town/city/country of birth, current address and occupation;
- A copy of the Certificate of Approval of a business name if applicable (check with the Office of Fair Trading to ascertain whether you are required to obtain approval of your business name);
- A completed 'Consent for criminal record check' form (for each licensee – for a corporation this must be completed for each director and each person concerned in the management of the corporation);
- A completed 'Fitness and Probity check' form (for each licensee – for a corporation this must be completed for each director and each person concerned in the management of the corporation);
- Certificate of Insurance/details of insurance in relation to the facility, showing that the facility is insured to a minimum amount of cover, as specified in the Act (i.e. $20,000,000 for each event; additional cover for procedures involving ionising radiation; and cover on a claims-made basis);
- Accreditation details, including details of the approved accrediting agency you have membership with, details of your next scheduled inspection, and a copy of the most recent accreditation report for the facility if available (see Accreditation).
- A list of procedures to be carried out, listing Medicare item numbers;
- If anaesthetic is to be used, a signed letter from an anaesthetist endorsing the procedures proposed, and the types of anaesthetics proposed.
- Current Authority to Practise for the Director of Nursing;
- Nursing Staff Registration details;
- Details of the Medical Advisory Committee - or proposed alternative to manage medical staff and credentialing (see Medical Advisory Committees).
- A copy of the lease agreement if you are not the owner of the building;
- A copy of the current development application from the relevant local council, for the use of the premises as a Class 9(a) Healthcare building;
- 2 copies of an architectural plan/s, drawn to a scale of 1:100, showing the dimensions of each part of the facility.