Applying for a declaration under the Commonwealth Qualified Privilege Scheme

How to apply for a declaration in relation to a quality assurance activity under Part VC of the Health Insurance Act 1973.

Page last updated: 24 April 2014

A person who wishes to seek a declaration in relation to a quality assurance activity under Part VC of the Health Insurance Act 1973 must do so by completing the approved application form. Applicants are required to provide a range of information including details about the design and expected outcomes of the quality assurance activity. It is essential that this application form be completed in full to ensure comprehensive and accurate assessment of the application against criteria set out in the legislation.

A declaration only relates to the specific quality assurance activity that is the subject of the application. It does not extend to associated or consequential quality assurance activities, these must be the subject of a separate application.

Application for a Declaration (PDF 566 KB)

Application for a Declaration (Word 593 KB)

When completed and signed, post your application to:

Director
Therapeutic Device Registers Section
Department of Health
MDP 67
GPO Box 9848
Canberra ACT 2601

If you require further information or a hardcopy of the application form, please contact us.