Request for masks

By filling this form you are consenting to sharing your personal and/or professional details and associated information with COORDINARE. The data provided by you and collected by COORDINARE including all consented personal information and relevant professional details provided in this process are part of COORDINARE’s systematic approach to support primary care services in responding to COVID-19 related activity and its associated regional planning and implementation of relevant support initiatives.
All collected data will be stored securely with COORDINARE and will only be used for direct service assistance initiatives undertaken by COORDINARE in collaboration with key strategic partner organisations - Illawarra Shoalhaven Local Health District and Southern NSW Local Health District. The raw data will only be accessible by key staff of the three aforementioned organisations. No unit record data or personal information will be shared with any external/third party whatsoever. The collected data will never be used by COORDINARE and its partner organisations for any commercial purposes including any form of marketing and/or advertising. Suitable aggregation of data will be done for any reporting purposes to the Australian Government Department of Health and COORDINARE will take all feasible/suitable steps to maintain complete confidentiality of all personal information collected during this process.

COORDINARE has a limited supply of masks for distribution as per Department of Health guidelines. If you are a healthcare provider that falls outside these criteria please check the Department of Health website for updates.

All requests for masks are subject to eligibility, prioritisation, and stock levels. Please note that gowns and other PPE are not available.

We ask that you confirm that you have read and understand the eligibility for access as per the guidelines here.

Please confirm you have read and understand the eligibility for access as per the guidelines linked above:
What are you requesting?
Are you currently undertaking testing for COVID-19 in your practice?
Are you currently undertaking aerosol generating procedures in your practice?