eReferral User Registration & Authorisation

The administrators/managers of the services need to provide the names of all staff members who will be authorised to use the S2S eReferral system. The administrators/managers should ensure that users of S2S comply with the Australian Privacy Act 1988 and the relevant State privacy acts.
If you need assistance in completing this form please contact the S2S Support Team(03) 9418 7466.

I,(Full Name)

from (Organisation Name as displayed in S2S)

Service as displayed in S2S
(ie. Allied Health: Physio) / Username
(if known) / Name of User / Email Address / Phone / S2S Role / Job Title / Action Request
Select ...PractitionerRCRC + PractitionerSCSC + Practitioner / Select ...AddEditRemove
Select ...PractitionerRCRC + PractitionerSCSC + Practitioner / Select ...AddEditRemove
Select ...PractitionerRCRC + PractitionerSCSC + Practitioner / Select ...AddEditRemove
Select ...PractitionerRCRC + PractitionerSCSC + Practitioner / Select ...AddEditRemove
Select ...PractitionerRCRC + PractitionerSCSC + Practitioner / Select ...AddEditRemove

verify that the people listed on the table below are staff members of thisOrganisation and Service and are authorised to perform the roles as described in the S2S eReferral System and that they have been advised of their obligations under theFederal and State privacy acts.

Key Contact Person/Agency Administrator: / Signature:______
Phone: Email: / Date:

The agency administratorMUSTinform the S2S team ()when a staff member leaves the organisation as well as providing the details above for any new staff member/s that join the organisation and wish to be involved in eReferral.

Please sign the completed form and fax to the S2S Support Team
Fax Number: (03) 9486 9344
Infoxchange Australia 33 Elizabeth Street,Richmond,Victoria, 3121 /