Purpose of this form
This form is for mobile app developers to enable you to:
- apply to the System Operator of the My Health Record system to have your organisation registered as a registered portal operator under the My Health Records Act 2012 (Cth); and
- request access to the My Health Record Test Environment for your proposed application (app).
For further information about connecting with the My Health Record system, please refer to the App Vendor Guide to the Connection Process, which is distributed as part of the Welcome Pack for developers using the FHIR® Gateway of the My Health Record system.
To register your organisation as a portal operator and nominate your representatives to be portal operator officers for the purposes of the My Health Record Act and the My Health Records Rule 2016 (Cth) (My Health Records Rule):
- Please complete all required sections of Part A of this form; and
- Ensure you have had the required documentation copies certified by acceptable authorities.
To request access to the My Health Record Test Environment for your app:
- Please complete all required sections of Part B of this form.
- If you do not know a specific detail required by Part B (e.g. a detail is still to be determined), please state this in the applicable response field. You may attach any additional information you feel is necessary to support your request.
Please complete Parts A and B (Button below)
When your organisation applies to the System Operator to register your organisation as a registered portal operator as a participant in the My Health Record system, personal information in this form will be collected by us as the System Operator of the My Health Record system. The purpose of collecting this personal information is (1) to verify your identity, the identity of your organisation and the role of each person nominated by your organisation to be appointed as your portal operator officer in the organisation, (2) to manage the My Health Record system; and (3) for the purposes of the My Health Records Act and the My Health Records Rule (Cth). Without this information your organisation cannot be registered as a portal operator in the My Health Record system.
Where you provide the personal information of another individual to appoint them as a portal operator officer, you confirm that the individual has agreed to provide their personal information to us for the purposes set out above.
If you apply for access to the My Health Record Test Environment, we (the System Operator of the My Health Record system) will collect personal information about you as the authorised person to apply for access, personal information of the people you describe in this form as the “Business Contact” and the “Technical/Testing Contact”, and your organisation’s name, which may contain personal information such as an individual’s personal name.
We will collect and use this personal information for the purposes of granting your organisation access to the Test Environment and contacting the relevant person for general enquiries about your organisation, app or application, for technical and testing purposes, and for administrative purposes.
Without this information your organisation and app will not be able to access the My Health Record Test Environment. A copy of your application, including any documents provided as evidence of identity, is kept by us for record keeping purposes. We will only disclose personal information about you or others you have included in this form to our contractors and delegates to assist us in operating the My Health Record system. Contractors and delegates are bound by strict obligations to treat individuals’ personal information with the same level of respect, privacy and security as we do. We will not disclose personal information included in this form overseas.
For a glossary of terms used in this form, please refer to the My Health Record Glossary available at: https://www.myhealthrecord.gov.au/glossary.
For support in completing this form, please contact the My Health Record Operations team at [email protected].
Complete Form - Parts A & B
 FHIR is a registered trademark of Health Level Seven International.