Register for Online Ordering
Register for Online Ordering
As a minimum please complete all
required
fields and then click Submit.
Provider type:
Select
Aboriginal Health Services
Aged Care & Nursing Homes
Child and Family Health Services
Correctional Services
Councils
GP Practices
Hospitals & Regional Health Services
Other Health Agencies
Pharmacy
SA Ambulance Services
AIR Provider Number:
Primary Contact First Name:
Primary Contact Last Name:
Principal GP:
AHPRA registration number:
AHPRA expiry date:
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December
2022
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2024
2025
2026
2027
S4 Licence number:
S4 Licence expiry date:
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November
December
2022
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2027
S4 licence PDF:
PRASA registration number:
PRASA registration expiry date:
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February
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April
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August
September
October
November
December
2022
2023
2024
2025
2026
2027
PRASA Premises Registration certificate PDF:
Name of organisation/practice:
Delivery Address:
Delivery Address 1:
Delivery Address 2:
Delivery Suburb:
Delivery Postcode:
Email for vaccine delivery communication:
Telephone:
Fax:
Opening hours for delivery:
Declaration
I acknowledge that as a requirement to receive government funded vaccines:
This facility complies with cold chain recommendations in the
National Vaccine Storage Guidelines - Strive for Five
.
Yes
No
All funded vaccines will be administered according to SA Health's vaccine eligibility criteria and the South Australian Immunisation Program Schedule.
Yes
No
Each funded vaccine dose administered in this facility will be notified to the
Australian Immunisation Register
(AIR). Click
here
to register for AIR access.
Yes
No
All employees submitting information to the Australian Immunisation Register are provided appropriate training or guidance to ensure accuracy of data submission. Click
here
to access eLearning resources.
Yes
No
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