Med Cert Requester

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Overview of your certificate requests

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Your details appear on every certificate request

Me

Provider Details

You — the requesting clinician

Full Name

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New Certificate Request

Complete all sections, then preview and send to the GP

Have an existing certificate? Import to pre-fill patient details.

1

Patient Details

Who is this request about?

First Name

Last Name

Date of Birth

ACC45 / Claim No.

NHI Number

Date of Injury

Phone

Email

Street Address

Suburb

City

Postcode

2

Sending To — GP Details

The GP who will issue the ACC18 certificate

GP Name

Practice Name

GP Phone

GP Email

ACC Provider No.

Certificate Needed By

3

Employer Details

The patient's employer — for coordination and return to work planning

Business / Employer Name

Manager Name

Manager Mobile

Manager Email

4

Current Clinical Situation

Injury status, functional progress, and relevant clinical findings

Clinical Summary

5

Normal Duties

Patient's pre-injury role — context for the GP

Job Title / Role

Normal Hours

Normal Duties Description

6

Return to Work Plan

Add phases — each maps directly to ACC certificate fields

Fully Unfit Fit for Some Work Fully Fit

Delete patient record?