Forms


This page contains the downloads for the Q Fever Register.


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Q Fever Register Downloads


Q fever Fact Sheet

Q Fever and the Australian Q Fever Register [ Download ] [ More Info ]

Forms that must be completed for each new patient being tested and/or vaccinated

Personal Details and Consent Form [ Download ] [ More Info ]
Pre-screening and Vaccination Form [ Download ] [ More Info ]

Forms that must be completed to become a Registered User

Application for an Organisation to Access the Register [ Download ] [ More Info ]
Individual User Registration Form [ Download ] [ More Info ]

Forms for practices that wish to be listed as a vaccine provider on the Register website

Application Form to be listed as a Q Fever Vaccination Provider [ Download ] [ More Info ]

System Documentation

Register User's Manual [ Download ] [ More Info ]
Secure Document Upload [ Download ] [ More Info ]

Other forms that may be useful for specific purposes

Employee Questionnaire for Employers &/or Medical Practices [ Download ] [ More Info ]

More Information


Q fever Fact Sheet

Q Fever and the Australian Q Fever Register

What is it?

The Fact Sheet contains introductory information about Q Fever and the Australian Q Fever Register, targeted at employees involved in a screening and vaccination programme.

How to use it?

We recommend that a copy of the Fact Sheet be given to each patient at the commencement of a screening and vaccination programme for their information.

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Forms that must be completed for each new patient being tested and/or vaccinated

Personal Details and Consent Form

What is it?

This form must completed by individuals before their information can be put on the Register. It contains their personal details (used to uniquely identify them), explains the use of the Register, and indicates that they have given their consent for their Q fever status information to be put on the Register.

Note: The form consists of two pages. The first page has fields for the patient to fill in with information. The second page has detailed information that the patient should read before signing the form. Patients must received both pages. A Q fever card cannot be issued if this form is not completed AND signed.

How to use it?

Give this form to patients. They should read the information then complete and sign the form.

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Pre-screening and Vaccination Form

What is it?

This form is for recording Q fever test results and whether or not a patient is vaccinated. It is the medical evidence of Q fever status that the Register has to have in order to issue a Q fever card. It is intended to be completed by the health professional(s) responsible for testing and vaccination.

Note: The form consists of two pages. The first page has fields to fill in with information. The second page has detailed information and instructions on how to complete the form.

How to use it?

Read the instructions and complete one form for each patient.

What to do once testing/vaccination is completed and forms are filled in?

Once skin and blood testing is complete and the patient is vaccinated (if appropriate) then the two forms should be checked to make sure they are complete: Personal Details and Consent Form AND Pre-screening and Vaccination Form. Make sure the patient has signed the Personal Details and Consent Form.

If the medical practice is a Registered User for the Q Fever Register then these two forms can be used to enter the relevant data onto the Register. Record the Register File Reference numbers in the appropriate place on the Pre-screening and Vaccination Form, and then mail/fax/email the completed forms to the Register.

If the medical practice is NOT a Registered User for the Q Fever Register then these two forms can be sent by mail/fax/email to the Register.

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Forms that must be completed to become a Registered User

Application for an Organisation to Access the Register

What is it?

This form is completed once for each organisation (medical practice or abattoir etc) wishing to submit data to, or query data from the Register. It contains the details of the organisation and describes the requirements of access to the Register.

How to use it?

The form should be completed and signed by an authorised representative of the organisation, after reading the Terms and Conditions attached to the form.

Note:This form is about the organisation. Only one copy is needed for each organisation. The next form is to provide details for the individual users within the organisation who wish to become a Registered User. An organisation registering for the first time will need to submit the Application for Access form AND one or more User Registration forms.

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Individual User Registration Form

What is it?

This form is to be filled in by each individual staff member within the organisation who will actually be doing the work ie accessing and using the Register. If more than one individual wishes to become a Registered User then each person should fill in a separate form.

How to use it?

Complete one form for each nominated user, and send it to the Register.

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Forms for practices that wish to be listed as a vaccine provider on the Register website

Application Form to be listed as a Q Fever Vaccination Provider

What is it?

The Register maintains a voluntary list on the website to allow people to search for practices that provide Q fever testing and vaccination services. This initiative stems from many years ago when only accredited medical practitioners could provide Q fever testing and when not every medical practice was accredited. Now, there is no longer any requirement for accreditation and any medical practitioner is able to provide Q fever testing and vaccination services. The list of vaccine providers is maintained by the Register as a courtesy. We update it when ever a practice informs us they wish to be added or removed.

How to use it?

Medical practitioners may use this form to request that their name be listed on this web site to help individuals or organisations seeking Q Fever vaccinations. Download and complete the form, then mail or fax to the Register office.

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System Documentation

Register User's Manual

What is it?

The manual contains full documentation of the Australian Q Fever Register Web site. This is an electronic copy of the Manual distributed to all participating organisations.

How to use it?

Use the flow charts for common operations, the site map to understand the structure of the Web site, or read the step by step instructions for each type of task.

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Secure Document Upload

Registered Users can find instructions for using the new secure document upload function.

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Other forms that may be useful for specific purposes

Employee Questionnaire for Employers &/or Medical Practices

What is it?

The Employee Questionnaire is a questionnaire that is not required by the Q Fever Register. It is provided because some employers or health professionals may be interested in gathering additional information on patient history and Q fever risk factors.

How to use it?

This form is not required by the Australian Q Fever Register. It may be used by an organisation for their own internal purposes.

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