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Purpose of this form
This is an application for assisted registration for a dependant under
the age of 18 years under the My Health Records Act 2012.
Registration for a My Health Record is voluntary.
Questions 1 – 4 must be completed by the person with parental
responsibility for this dependant.
You can also register free of charge online at www.myhealthrecord.
gov.au, by phoning 1800 723 471, by mail using a different form,
or in a Medicare Service Centre.
Important: You need to re...