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HealthSecure user registration form

Complete this form to apply for a digital certificate as an individual user.

ACC is acting on behalf of the New Zealand Health & Disability Sector Registration Authority (NZHSRA) to process digital certificate applications for ACC and the Ministry of Health.

What you need to fill out this form

Your organisation’s contact details, including a named, main contact person.
The user’s contact details.
Know which applications/systems you’d like to access eg ACC, CareConnect, Special Authority, etc.

When you have all the relevant information, please allow around five minutes to enter it, as the form can’t be saved.

Need help?

If you need help to complete this form, please call NZHSRA.

Phone 0800 117 590

Your privacy

In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982. For further details see ACC’s privacy policy.

Our privacy notice

Complete the form below:

Organisation details

Organisation name as registered with NZHSRA:

Work phone number of main organisation contact:

Email of main organisation contact:

Applicant's details for certificate

Name:

Job title:

Work phone:

Mobile:

Unique email for the user themselves:

Email address for receiving yearly renewal reminder:

Application access

Please indicate which organisation's application/s you are applying for access to. You can choose more than one.

If you are unsure, call the NZHSRA.

Phone 0800 117 590.

You will need to apply for individual user access directly with the application owner.

What application/s do you need a digital certificate for?

ACC electronic transactions

CareConnect CareConnect (For specialists and allied health providers using a portal to send referrals to Health New Zealand IN Auckland and Northland. Not applicable to GP practices)

HIN (Health Intranet Network)

NHI (National Health Index)

NIR (National Immunisation Register)

NZCSP (NZ Cervical Smear Programme)

Special Authority

Other

Authorised signatory

Declaration

This section must be completed by an authorised signatory in your organisation, as supplied in your organisation’s registration with the NZHSRA.

I declare that the information given in this form is true and correct, and that I authorise the NZHSRA (as the accredited Registration Authority) to verify this information. I accept that the NZHSRA may decline any application or revoke any certificate at

Authorised signatory name:

Authorised signatory job title:

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