Application for appointment as a Council Directed Health Assessor

1. Personal details

Postal Address

Practice Location

2. Professional experience

Please provide a brief description of your relevant professional experience (up to 500 words)

3. Professional registration and certification
attachment
4. Professional referee reports

Professional referee reports are required to assess whether you have the demonstrated experience within the nominated engagement.

You are required to provide at least two (2) completed and signed referee reports and your professional CV. The referee reports must relate to:

  • engagements during the past three years
  • nominated engagement types.

The Applicant Referee Report template is attached to this form.

Referees
We may contact your referees to verify or clarify any aspect of the referee report. 
*Maximum file size for the referee report is 5MB and must be in PDF Format.

Files must be less than 5 MB.
Allowed file types: pdf.
Files must be less than 5 MB.
Allowed file types: pdf.
Files must be less than 5 MB.
Allowed file types: pdf.
Location of professional practice and availability
5. Location of professional practice and availability

Please complete the following section indicating the location/s you are able to undertake health assessments and your availability at each location.

1. METROPOLITAN

1. METROPOLITAN

2. REGIONAL

2. REGIONAL

3. INTERSTATE

3. INTERSTATE

Telehealth / videoconferencing availability
6. High priority health assessments

HPCA seeks to ensure that all new health assessments occur within 45 days of the Council referring a practitioner to a health assessment. In cases which are deemed high priority, a health assessment may be required within 14 days.

Please complete the following questions regarding high priority health assessments.

7. Pricing framework for psychiatrists and neuropsychologists

Please complete this section if you are a psychiatrist or neuropsychologist. The payment questions below detail the maximum payment rates for standard and complex assessments. It also includes the fees payable for supplementary reports, non-attendance and cancellation fees, and fees for providing additional information or evidence to a hearing.

For further information, please refer to Schedule D – Maximum Pricing Framework in the Terms and Conditions.

8. Pricing framework for other health practitioners

All health practitioners (other than psychiatrists and neuropsychologists) are required to complete this section. The pricing framework requires health practitioners to specify their standard fee and total time required to produce an Assessment Report

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The pricing framework requires health practitioners to specify their complex fee and total time required to produce an assessment report.

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