Facility contact information Facility Contact Information Form Please complete all relevant fields to ensure accurate communication and service from the laboratory. InstagramThis field is for validation purposes and should be left unchanged.Facility detailsFacility name(Required)Address Street Address Address Line 2 City Post code Phone (include area code)(Required)Primary Health Organisation (PHO)(Required)Practice Management System (PMS)(Required)EDI number / identifierEmail contactsEmail – General communications / newsletter(Required) Enter Email Confirm Email Email – For patient details(Required) Enter Email Confirm Email After-hours & emergency contactAfter-hours phoning process / instructions(Required)e.g. Call the requesting doctor first, then after hoursFirst point of contact out of hoursFollow-up contact out of hoursPractice ManagerPractice Manager name(Required) First Last Practice Manager email(Required)Practice Manager phone (include area code)(Required)Are you currently set-up/using eOrders (our electronic test ordering system)?Please select from the options belowYesNoPlease advise why you aren't using eOrdersWould you like more information on eOrders?Select from below optionsYes pleaseNo thank youOpening hoursPractice opening hours(Required)Additional contact informationOther contact details that may be useful for the laboratorye.g. Lead Nurse, ITCAPTCHA Δ
