Enrol for DIAS – HDAA onTrack

Enrolment for diagnostic imaging accreditation scheme

Fill in the required details below to begin your enrolment for the Diagnostic Imaging Accreditation Scheme.

Fields marked with an asterisk* are required.

SECTION A : Practice contact details

Practice contact details

LSPN*
Location Specific Practice Number - onTrack login.

Trading Name*

Group Name If this practice is one site of a group or business with multiple sites, please enter the group name here.

Are you applying for* A Diagnostic Imaging Practice
A Base for Mobile Equipment

HDAA onTrack password

This password allows your practice to access onTrack once HDAA have verified your enrolment details.

Choose a Password* Must be greater than five (5) characters

Confirm Password*

Practice or Base physical address

This address is the physical location of the practice or where mobile equipment is usually housed. In the case of the mobile equipment, this is not the physical location where the mobile equipment is taken.

Floor Number & Building

Street Number and Name*

Suburb

Town or City*

State/territory*

Postcode* Find your postcode...

Postal address

Use physical address as postal address

Preferred accreditation contact

Important: The preferred accreditation contact must be a person who can verify and agree to the terms and conditions, and to whom correspondence about accreditation can be directed.

First Name*

Last Name*

Position*

Phone (work)*

Mobile (work)*

Facsimile (work)

E-mail Address (work)*

Proprietor's Name*

Proprietor's Email Address

Other Practices* As the preferred contact I am responsible for other diagnostic imaging practices participating in the accreditation scheme.
This is the only practice participating in the accreditation scheme I am responsible for.

SECTION B : Practice Information

Imaging services

Equipment used to provide these services must be registered to your LSPN. See eligibility for DIAS

Services Provided* Ultrasound
X-ray
Mammography
Angiography
Fluoroscopy
OPG
MRI
CT
Nuclear Medicine Imaging

Number of Imaging Equipment Items* How many units are at your practice or mobile base?

Number of Full-time Imaging Practitioners* If you have no full-time practitioners, enter '0'.

Number of Part-time Imaging Practitioners* If you have no part-time practitioners, enter '0'.

SECTION C : Payment and Verification

Fee

Choose your Required Accreditation. See Schedule of Fees and Terms and Conditions

Select Your Required Accreditation Level*

Amount payable: Cannot be calculated until you have completed the number of full-time and part-time practitioners

Payment

Payment Information - Electronic Bank Transfer:
For bank transfer, the LSPN must be shown in the Invoice number/details section of your online banking payment.
Bank: HSBC Bank Australia Limited
Account name: Business Cheque Account
BSB: 343-001
Account Number: 393735001

Verify authenticity

Please review the information you have entered for accuracy, ensuring that at minimum all the compulsory fields are completed. Giving false or misleading information is a serious offence. Full terms and conditions are available on this website.

Person Completing Form*

Verification* I confirm I have permission to act on behalf of the LSPN site above, and that I am able to authorise this enrolment with HDAA Australia Pty Ltd for the Diagnostic Imaging Accreditation Scheme and verify the completeness and accuracy of the information provided in this enrolment and associated application documentation (when submitted for audit) for the Diagnostic Imaging Accreditation Scheme. I understand and accept on behalf of this LSPN the terms of HDAA Membership and the schedule of fees. I agree that the first installment of fees will be paid on receipt of invoice and understand the terms of the Fee Structure selected and confirm all invoices will be paid within seven (7) days of receipt.