Page 1

13 fields

Fields on page 1

APA number

APA name

for a new APL

to renew an existing APL

to relocate an existing APL

to amend an existing APL

APL number

GX (General)

GY (General)

B (Branch)

M (Medical)

S (Special)

Page 2

52 fields

Fields on page 2

Laboratory name

Building name

Unit

Suite

Shop

Floor

Street number

Street name

Suburb or town

State

Postcode

Postal address (if different to above)

1.Lab PostalAdd3

Postcode

Yes

Closure date (DD

date (DD MM YYYY)

(DD MM YYYY)

Yes

New laboratory address Laboratory name

Building name

Unit

Suite

Shop

Floor

Street number

Street name

Suburb or town

State

Postcode

Postal address (if different to above)

1.Rel PostalAdd3

Postcode

Commencement

date (DD

date (DD MM YYYY)

Mrs

Miss

1.Auth SalutOther

Dr Mr Mrs Miss Ms Mx Other Full name

Position held

Daytime phone number (including area code)

Mobile phone number

This is the email address we will use to notify you of the outcome of your application.

Page 3

63 fields

Fields on page 3

Mrs

Miss

Other

Dr Mr Mrs Miss Ms Mx Other Full name

Position held

Daytime phone number (including area code)

Mobile phone number

Mrs

Miss

Other

Family name

First given name

Approved pathology practitioner

Mrs

Miss

of the APP behalf at this

Family name

First given name

APP number

Designated person’s qualification

Relevant experience

Hours in attendance at this

Yes

APL number

APL name

Building name

Unit

Suite

Shop

Floor

Street number

Street name

Suburb or town

State

Postcode

Hours in attendance at

APL number

APL name

Building name

Unit

Suite

Shop

Floor

Street number

Street name

Suburb or town

State

Postcode

Hours in attendance at

Page 4

45 fields

Fields on page 4

APL number

APL name

Building name

Unit

Suite

Shop

Floor

Street number

Street name

Suburb or town

State

Postcode

Hours in attendance at

N/A

Yes

What are the normal laboratory

days

equivalent (FTE) staff are in part-time staff member working 20 0.5 FTE)

0.5 FTE)

1.App TechnicalNumber

1.App ScientistNumber

1.App OtherNumber

Group P1 – Haematology

Group P2 – Chemical

Group P3 – Microbiology

Group P4 – Immunology

Group P5 – Tissue Pathology

Group P6 – Cytology

Group P7 – Genetics

Group P8 – Infertility and pregnancy tests

Group P1 – Haematology

Group P2 – Chemical

Group P3 – Microbiology

Group P4 – Immunology

Group P5 – Tissue Pathology

Group P6 – Cytology

Group P7 – Genetics

Group P8 – Infertility and pregnancy tests

Date pathology

pathology group(s) to be

group(s) to be removed (DD

A copy of the latest Advisory or Assessment Report

If your APL has expired and you wish to request a

Page 5

7 fields

Fields on page 5

• giving false

Authorised representative’s full name

Date (DD MM YYYY)

(DD MM YYYY) (you

YYYY) (you must date this

Signature (only required if returning by post or if someone other than the person named submits this form through HPOS)

Healthcare Federal · HW010

Application for approval, amendment or renewal of premises as an accredited pathology laboratory (HW010)

This form is used by approved pathology authorities to apply for, renew, or amend approval of premises as an accredited pathology laboratory under Medicare.

Issued by: Services Australia
Form number: HW010
Jurisdiction: Federal
Length: 5 pages

When do you need this form?

You need this form if you are an approved pathology authority operating or planning to operate a pathology laboratory that needs Medicare accreditation. This includes new laboratory approvals, renewals of existing approvals, relocations to new premises, or amendments to current laboratory details.

What you'll need

APA (Approved Pathology Authority) number and name
Current APL (Accredited Pathology Laboratory) number if renewing or amending
Laboratory address details and postal address
Copy of latest Advisory or Assessment Report from NATA (National Association of Testing Authorities)
Closure date if laboratory is closing or relocating

Where to send it

Submit the completed form through HPOS (Health Professional Online Services) or send by mail to Services Australia. Applications submitted through HPOS may require physical signatures depending on who submits them.

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