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About Us
Products
Provider Network
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Contact Us
- FAQs
Blog

Home
About Us
Products
Provider Network
- Join Our Network
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Contact Us
- FAQs
Blog

Become a Provider: HospitalleadwayDev2023-06-06T09:59:20+01:00

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Practice Name

Address

State

Local Government

Suburb/Town

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Branch Address

Suburb/Town

State

Local Government

Add Another branch

Branch Address

Suburb/Town

State

Local Government

Add Another branch

Branch Address

Suburb/Town

State

Local Government

Add Another branch

Branch Address

Suburb/Town

State

Local Government

Add Another branch

Branch Address

Suburb/Town

State

Local Government

Hospital Phone Line 1

Hospital Phone Line 2

Email for portal access

Name of Managing Director

Name of Primary Contact Person

Name of Secondary Person

Email of Managing Director

Mobile No. of Primary Contact Person

Mobile No. of Secondary Person

Facility available days & time

Open From

Bank Account Name

Bank Name

Bank Account Number

Claims Payment Frequency

Types of Ward

General Ward

Three-bed

Do you have HDU

(if available, state the number of beds)

Do you have ICU

(if available, state the number of beds)

Confirm the availability of the following

Ambulance Available?

24-hr Ambulance Coverage?

In-house Laboratory

In-house X-Ray

CT Scan Machine

MRI Machine

Mammogram

Ultrasound Scan

ICU

Haemodialysis

Available Specialists

please select the days that apply

Cardiologist

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Cardiothoracic Surgeon

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Dermatologist

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Endocrinologist

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

ENT Surgeon

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Gastroenterologist

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Copy of CAC registration certificate

Copy of Evidence of Registration with the relevant state accreditation agency

Copy of Certificate of Medical Indemnity Insurance as detailed under section 8 of the agreement

Upload Practice Licenses of Professional Staff

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