User Account Form

*Please select required accounts...
Computer Account Email Account MMEx User LogiQC User Timeclock Tag

Manager/Supervisor Details

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*Option* Add an alternate/admin contact to
receive the new user details
NOTE: Please add only 1 x email address

User Details

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Is a desk phone required?

Do you have an existing tag:

Computer Account Details

* Max 20 characters

Email Account Details

MMEx Details

MMEx Job Role NOTE: Prescriber numbers are compulsory for Doctors/Specialists/Nurse Practitioners AHPRA Numbers are compulsory for all Nurses HPI-I > Healthcare Provider Identifier - Individual
Reception
Cert III Aboriginal Health Worker * Select only if user is employed as a Health Worker
Cert IV Aboriginal Health Worker * Select only if user is employed as a Health Worker
Aboriginal Health Worker Student
Nurse Renal Nurse Enrolled Nurse
Doctor
Nurse Practitioner
Doctor Student
Specialist
Allied Health Worker
Medicare
Imprest
Sexual Health Access (these are not job roles)
Mental Health Access (these are not job roles)

If you are unsure of what role to select, please call the KAMS MMEx Helpdesk on 91943224 option 2

Location(s) required NOTE: Provider numbers are compulsory for Doctors & Specialists
Beagle Bay Clinic Medicare Location ID: UWA10004	DAHS Medicare Location ID: UWA10002
Bidyadanga Medicare Location ID: UWA10004	Kupungarri Medicare Location ID: UWA10002
Headspace Medicare Location ID: UWA10005	Imintji Medicare Location ID: UWA10002
Balgo Medicare Location ID: UWA10004	Dodnun Medicare Location ID: UWA10002
Billiluna Medicare Location ID: UWA10004	Ngallagunda Medicare Location ID: UWA10002
Mulan Medicare Location ID: UWA10004	Jarlmadangah Medicare Location ID: UWA10002
KRS Kimberley Medicare Location ID: UWA10004	Kandiwall Medicare Location ID: UWA10002
KRS Broome Medicare Location ID: UWA10004	Pandanus Park Medicare Location ID: UWA10002
KRS Derby Medicare Location ID: UWA10004	OVAHS Medicare Location ID: UWA10022
KRS Kununurra Medicare Location ID: UWA10004	YYMS Medicare Location ID: UWA10003
KRS Fitzroy Crossing Medicare Location ID: UWA10004	Ringer Soak Medicare Location ID: UWA10003
KRS Mobile Dialysis Unit (MDU) Medicare Location ID: UWA10004	BRAMS Medicare Location ID: UWA10029
	Germanus Kent

MMEx Training
Is MMEx Training required?

Please suggest a training date/time
NOTE: Please do not request Fridays - as they are usually unavailable due to meetings and other tasks

Please be aware:

MMEx Training schedule is prepared up to 4 weeks in advance
Dates/Times selected are requests only, MMEx Trainers will do their best to be as close to the request as possible, pending availability
Training request will be confirmed/updated via a separate email/call from trainer
Rescheduling/Cancelling/Late Arrivals - Please notify help desk as soon as possible if you are unable to attend a scheduled training session, rescheduling options are often very limited

Any additional notes/information for this account or training

Email address to receive MMEx login details:
Leave blank if details are to be sent to Manager's email