Forms for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream 012-10010070

Practice Incentives forms list

Table 1

Note: versions of the form ending in 2410 and 2411 were updated to 2412 as a result of adding Mx to the forms. No other significant changes were made and both version of the form are acceptable.

Current form number and version	Form name	Old form version cut-off date
IP001.2412	Practice Incentives application form	IP001.2211 - 31 January 2025 Earlier versions are no longer accepted.
IP002.2404	Practice Incentives Program eHealth application	Note: Program Management will issue this form in exceptional circumstances.
IP003.2412 IP003.2410	Practice Incentives Individual general practitioner or nurse practitioner details form	IP003.2107 - 31 January 2025 Form titled: Practice Incentives Individual general practitioner, nurse practitioner or health professional details form Earlier versions are no longer accepted.
IP004.2412 IP004.2410	Practice Incentives Program Procedural General Practitioner Payment application form	IP004.2107 - 31 January 2025 Earlier versions are no longer accepted
IP005.2412 IP005.2410	Practice Incentives Change of practice details form	IP005.2205 - 31 January 2025 Earlier versions are no longer accepted
IP006.2412 IP006.2410	Practice Incentives Program Teaching Payment claim form	IP006.2305 - 31 January 2025 RTF (Word) versions are no longer accepted unless they meet the university certification criteria below. If the version of the form was dated by the university before the cut-off date, that form is acceptable. Eligible university certification dates for previous versions: IP006.2305 - 1 May 2023 to 31 January 2025 IP006.2011 - 1 November 2020 to 31 December 2023 IP006.1808 - 1 August 2018 to 31 January 2021 Earlier versions are no longer accepted.
IP007.2412 IP007.2410	Practice Incentives Practice closure or withdrawal form	IP007.2107 - 31 January 2025 Earlier versions are no longer accepted
IP008.2412	Practice Incentives Practice ownership details and declaration form	IP008.2107 - 31 January 2025 Earlier versions are no longer accepted.
IP010.2501 IP010.2411 IP010.2412	Practice Incentives Change of practice ownership form	IP010.2107 - 31 January 2025 Earlier versions are no longer accepted.

IP017.2410	Practice Incentives Program Indigenous Health Incentive patient registration and consent form	IP017.2311 - 31 January 2025 Earlier versions are no longer accepted. RTF (Word) versions are no longer accepted
IP025.2412	Practice Incentives Additional practice branch	IP025.2107 - 31 January 2025 Earlier versions are no longer accepted.
IP026.2412 IP026.2410	Practice Incentives Program Indigenous Health Incentive practice application form	IP026.2211 - 31 January 2025 Earlier versions are no longer accepted.
IP027.2412 IP027.2410	Practice Incentives Review of decision form	IP027.2107 - 31 January 2025 Earlier versions are no longer accepted.
IP029.2412 IP029.2410	Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent form	IP029.2107 - 31 January 2025 Earlier versions are no longer accepted.
IP030.2412 IP030.2410	Practice Incentives Program After Hours Incentive application	IP030.2107 - 31 January 2025 Earlier versions are no longer accepted.
IP032.2107	Practice Incentives Overpayment information and summary sheet	Note: this form is for internal use only.
IP033.2410	Practice Incentives Program Quality Improvement application	Note: Program Management will issue this form in exceptional circumstances.

Signatory requirements

Table 2: outlines signature requirements for the declaration on Practice Incentives forms only. Signature requirements for other documents may vary.

Form name and number

Completed by

Practice Incentives application (IP001) form
Practice Incentives Practice ownership details and declaration (IP008)
Practice Incentives Change of practice ownership (IP010) form
Practice Incentives Practice closure or withdrawal (IP007) form

Individual Proprietor

The individual owner must sign the declaration

Partnership

At least 2 partners must sign the declaration

Company

At least one director must sign the declaration

Trust

At least one trustee must sign the declaration. If trustee is a company at least one director must sign the declaration

Body Corporate

At least 2 representatives must sign the declaration

State or territory government or other public body

At least 2 officers must sign the declaration

Note: if the practice has submitted an older acceptable form and selected Associateship, determine the correct ownership structure. Assess the signature requirements based on that.

The owners signing an IP007 must be listed on the practice profile as practice owners

Practice Incentives Change of practice details (IP005)

One owner on the practice profile must sign the declaration if the request is for or includes:

Changes to authorised contact persons
Relocation
Amalgamation

One owner or authorised contact person can sign the declaration if the request is for any of the following:

Bank account details
Ceasing general practitioners or nurse practitioner
Updating health professional details only

Practice Incentives Individual general practitioner or nurse practitioner details form (IP003)

For most notifications:

the general practitioner or nurse practitioner must sign the practitioner declaration
an authorised contact person must sign the practice declaration

See Practitioners in PIP and WIP - Practice Stream for signature requirements for specific notifications.

All other forms

An authorised contact person on the practice profile must sign the declaration.

Forms signed by a contact person who has since been removed are acceptable if it was signed and dated before the contact was removed from the profile. See Table 2 on the Process page.

Note: an owner on the practice profile can sign the declaration in place of an authorised contact person.

Online changes requiring a form

Table 3:

Practice update	Form required
Online application	Practice Incentives Practice ownership details and declaration (IP008) and supporting documents
Relocation	Practice Incentives Change of practice details (IP005) and supporting documents
Change of ownership	Practice Incentives Change of practice ownership form (IP010) and supporting documents
Accreditation	Current accreditation or registered for accreditation certificate. External users cannot update or amend accreditation details online
Closure/withdrawal	Practice Incentives Practice closure or withdrawal form (IP007) - external users cannot close or withdraw a practice online
Procedural GP	Practices cannot register a GP for procedural payments. The GP must submit a Practice Incentives Individual general practitioner or nurse practitioner details form (IP003)

Forms

Practice Incentives Program forms

Services Australia

Practice Incentives Program