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This form is to be completed by Open Prescription Delivery or Active Script List Registry Service software vendors.

By submitting this form, you are consenting for the Australian Digital Health Agency (the Agency) to disclose the information in this form about you, your organisation and your product to the Department of Human Services (DHS) and contractors. You are consenting to the Agency’s use and storage of the information to assist you in testing your product against Electronic Prescribing system requirements and, if successful, monitoring the ongoing conformance of your product. Please ensure all information is correct.

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