• Provider On Boarding Agreement Form

    Provider On Boarding Agreement Form

  • 1. Provider Details

  • Format: (000) 000-0000.

  • 2. Services Offered

  • Select the services you are seeking approval to provide

  • 3. Compliance & Required Uploads

    Upload documents and confirm compliance with aged care, disability and privacy obligations.

  • 3. Compliance Uploads

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  • Browse Files
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  • Browse Files
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  • Browse Files
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  • Browse Files
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  • Browse Files
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  • 4. Pricing & Payment

    Provide your proposed rates. Final rates are subject to approval and program funding rules.

  • 5. Preferred Provider Agreement

    Review the key agreement terms before submitting your application.

  • The Provider must submit accurate invoices with supporting records. Audit may withhold, reject or delay payment where services are disputed, documentation is incomplete, rates are not approved, compliance evidence is missing, or funding rules are not satisfied.

    9. Audit and Quality Review
    Audit of provider records, may request evidence, review client feedback, investigate complaints, assess service quality, and require corrective action.

    10. Suspension and Termination
    MDHSS may immediately suspend or terminate provider access where concerns arise regarding client safety, professional conduct, compliance failure, insurance lapse, documentation failure, complaint investigation, fraud, confidentiality breach, conflict of interest or reputational risk.

    11. Confidentiality, Privacy and Data Security
    The Provider must protect all client, organisational, financial, clinical and operational information and must not disclose, copy, store or use MDHSS information except for authorised service delivery.

    12. Governing Law
    This agreement is governed by the laws of Victoria, Australia. 

  • Compliance with all relevant laws, regulations, and related policies

  • 6. Declaration & Digital Signature

    The authorised representative must complete this section.

  • Date*
     - -

  • On Submit all information and uploaded files will be submitted for provider onboarding, compliance review, service allocation and agreement administration. We'll contact you promptly.

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