EPiC Account Access Request

He Ako Hiringa's EPiC is a prescribing data analytics tool that can be used to explore practice prescribing behaviours and how they relate to national problems of prescribing practice. EPiC is developed by Matui Limited, under contract to Pharmac. Click here to learn more about EPiC.

Use of EPiC is subject to Matui's Condition of Use and Privacy Policy.
EPiC Account Access Request

User account access form request
I, the undersigned, request EPiC account user access for the sole purposes of undertaking clinical quality or education activities on behalf of the general practice/s named in this form. *

First Name Middle Name Last Name
I UNDERSTAND THAT THE USE OF ANY MATUI LIMITED PRODUCTS (MATUI) INCLUDING HE AKO HIRINGA WEBSITE, EPiC PRESCRIBING DASHBOARDS AND OTHER BRANDED HE AKO HIRINGA CONTENT CONSTITUTES YOUR AGREEMENT TO BE BOUND BY THE TERMS AND CONDITIONS OF USE (‘TERMS OF USE’). I UNDERSTAND THE COLLECTION OF DATA PROVIDED IN THIS FORM IS SUBJECT TO MATUI'S PRIVACY POLICY. *

Accept
Signature *

Clear
Date Signed *

Month Day Year
Date
Requester details

Complete to provide the full contact information of the person who is requesting EPiC account access
Requester's job title *
Requester's workplace *
Requesters mobile phone *
Enter a New Zealand mobile phone number
Requester's email *
example@example.com
Requester's professional registration number (if applicable)
Additional information for the Approver
Requester's EPiC account login email
Please provide your EPiC account login if held, or email to be used with EPiC Practice account.
Practices requested

Complete to provide the names and HPI Facility Numbers of the requested practices
Note: One request, for one or more practices, to be completed per Approver.
Ministry of Health HPI Facility look up table.
I request access for Practice Name : Type a label*
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
I request access for Practice Name : Type a label
Address: Street Address Address Line 2 City State Zip
Length of access requested

Indicate the duration of access
Duration of access
You will be contacted after the period to arrange renewal if required.
Approver details

Receiver to complete the company ownership details of the practice/s requested and the contact details of an authorised company representative (the Approver).
Company name *
NZBN Number *
Look up NZBN number
Name of authorised Approver *

First Name Last Name
Title of Approver *
Approver must have authority to sign on behalf of the business.
Workplace email of Approver *
example@example.com
Should be Empty:

EPiC Account Access Request

Requester details

Practices requested

Length of access requested

Approver details