Forms

This page contains the downloads for the Q Fever Register.

Q Fever Register Downloads

Q FEVER FACT SHEET

PATIENT FORMS

AUTHORISED USER FORMS

VACCINE PROVIDER FORMS

SYSTEM DOCUMENTATION

OTHER

  • Employee Questionnaire for Employers &/or Medical Practices [ Download ]
  • Q FEVER FACT SHEET

    Q Fever and the Australian Q Fever Register

    What is it?

    The Fact Sheet contains introductory information about Q Fever and the Australian Q Fever Register, targeted to employees involved in a screening and vaccination program.

    How to use it?

    We recommend that a copy of the Fact Sheet be downloaded at the commencement of a screening and vaccination program for their information.

  • PATIENT FORMS

    Forms that must be completed for each new patient being tested and/or vaccinated.

    Personal Details and Consent Form

    What is it?

    This form must be completed by individuals before their information can be added to the Register. It contains their personal details (used to uniquely identify them), explains the use of the Register, and indicates that they have given their consent for their Q Fever immune status information to be put on the Register.

    Note: The form consists of two (2) pages. The first page has fields for the patient to fill in with information. The second page has detailed information that the patient should read before signing the form. Patients must complete both pages.

    How to use it?

    Provide this form to patients. They should read the information then complete and sign the form if they want their information added to the Register.

    Note: A Q Fever eStatement can only be issued if this form is completed and signed.

    Pre-screening and Vaccination Form

    What is it?

    This form is for recording Q Fever test results and whether or not a patient is vaccinated. It is the medical evidence of Q Fever immune status that the Register has to have in order to issue a Q Fever eStatement. It is intended to be completed by the health professional(s) responsible for testing and vaccination.

    Note: The form consists of two (2) pages. The first page has fields to fill in with information. The second page has detailed information and instructions on how to complete the form.

    How to use it?

    Read the instructions and complete one (1) form for each patient.

    What to do once testing/vaccination is completed and forms are filled in?

    Once skin and blood testing is complete and the patient is vaccinated (if appropriate) then the two (2) forms should be checked to make sure they are complete: Personal Details and Consent Form AND Pre-screening and Vaccination Form.Make sure the patient has signed the Personal Details and Consent Form.

    If the medical practice is an Authorised User of the Q Fever Register then the information from these two (2) forms can be used to register each patient onto the Register.

    Complete both forms and upload to the Register for subsequent checking and verification by Register staff.

    If the medical practice is not an Authorised User for the Q Fever Register then these two (2) forms can be forwarded to the Register by email (preferred), facsimile or post.

  • AUTHORISED USER FORMS

    Forms that must be completed to become an Authorised User

    Application for an Organisation to Access the Register

    What is it?

    This form is completed once for each organisation (medical practice or abattoir etc) wishing to submit data to, or query data from the Register. It contains the details of the organisation and describes the requirements of access to the Register.

    How to use it?

    The form must be completed and signed by an authorised representative of the organisation, after reading the Terms and Conditions attached to the form.

    Note: This form is about the organisation. Only one (1) copy is needed for each organisation. A separate form is required to provide details for the individual users within the organisation who wish to become an Authorised User. An organisation registering for the first time will need to submit the Application for an Organisation to Access the Register form and one or more Authorised User Application forms.


    Authorised User Application form

    What is it?

    This form is to be filled in by each individual staff member within the organisation who will actually be doing the work i.e. accessing and using the Register.

    Note: If more than one individual wishes to become an Authorised User then each individual must complete and submit a separate form.

    How to use it?

    Complete one (1) form for each nominated user, and submit the form to the Register.

  • VACCINE PROVIDER FORMS

    Forms for practices that wish to be listed as a vaccine provider on the Register website

    Application to be listed as a Q Fever Vaccination Provider

    What is it?

    The Register maintains a voluntary list on the website to enable individuals to search for Medical Practices that provide Q Fever testing and vaccination services. Medical practitioners may use this form to request that their business is listed on this website.

    The list of vaccine providers is maintained by the Register as a courtesy. It is only updated when a medical practice informs the Register of changes.

    How to use it?

    Download and complete the form and forward to the Register by email (preferred), facsimile or post.

  • SYSTEM DOCUMENTATION

    For Use by Authorised Users Only.

    Authorised User's Guide

    What is it?

    The guide contains full documentation of the Australian Q Fever Register website. This is an electronic copy of the Guide distributed to all participating organisations.

    How to use it?

    Use the flow charts for common operations, the site map to understand the structure of the website, or read the step by step instructions for each type of task

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