Primary Sense Registration Form

Country to Coast, QLD (CCQ), your local Primary Health Network is expanding its commitment to quality improvement for our general practices and in turn their patients and our communities through the implementation of the Primary Health Network developed population management and clinical audit tool – Primary Sense.

The first step for your General Practice is to complete this registration form, and if you have any questions please contact us: pracsupport@c2coast.org.au

Watch a 1 minute introductory video about Primary Sense here to learn more about the benefits to your practice. Learn more about Primary Sense on our Primary Sense webpage. Primary Sense is currently compatible with Best Practice and Medical Director (excluding Helix) clinical software.

This is an exciting time for us to work together as we further enhance data use to better inform quality improvement outcomes for your practice and our community.

Upon submission of the Primary Sense Registration form, your practices Authorised Signatory will receive a Primary Sense Data Sharing + Software Licence Agreement from pracsupport@c2coast.org.au for review and signature.

CCQ collects information in line with our Privacy Policy. Please refer to our Privacy Policy for further information: https://c2coast.org.au/our-privacy-matters/

Practice Name *

Practice ABN *Please ensure your ABN matches your Practice Name. You can check this by doing an ABN lookup: https://abr.business.gov.au/

Practice Address *

Suburb *

Postcode *

Practice phone *

Practice email *

Is your practice part of a corporate group? *

YesNo

Please provide the name of the corporate group your practice is part of: *

Primary Sense is currently only compatible with Best Practice and Medical Director clinical software. Please select the clinical software used at your practice. *

Best PracticeMedical Director (excluding Helix)Other

If other, please specify:Please note that Primary Sense is currently compatible with Best Practice and Medical Director. We will keep you updated on compatibility with other software.

Does your practice participate in the PIP QI Incentive? *

YesNo

Does your practice have a Shared Database with another practice site? *

YesNo

Additional practice 1: Practice name *

Additional practice 1: Telephone *

Additional practice 1: Address *

In addition to the above practice, does your practice have a Shared Database with another practice site? *

YesNo

Additional practice 2: Practice name *

Additional practice 2: Telephone *

Additional practice 2: Address *

Practice Primary Contact Name *Please nominate a practice contact for Primary Sense™ related matters

Primary Contact Email *

Primary Contact Phone *

Name of Practice Owner/person with the authority to sign the Practice Data Sharing Agreement *PLEASE NOTE: This must be someone with the appropriate legal authority to sign documents on behalf of the practice

Email of Practice Owner/person with the authority to sign the Practice Data Sharing Agreement *PLEASE NOTE: The Data Sharing Agreement will be emailed to this contact email

Role of Practice Owner/person with the authority to sign the Practice Data Sharing Agreement *

IT Provider Name *

IT Provider Email Address to send Primary Sense™ install instructions *

IT Provider Contact Phone *

By checking this box the Practice confirms that you give permission for CCQ to contact your IT provider regarding Primary Sense™ Installation *