Victoria's Single Employer Model trial for Rural Generalist Trainees – for primary care providers

Welcome

Thank you for your interest in participating in the Single Employer Model Trial.

This form is for primary care providers that are interested in hosting Single Employer Model trainees in 2027 and 2028. For more information on the Single Employer Model trial, see Single Employer Model | health.vic.gov.au.

Submitting this form does not guarantee that a trainee will be placed at your practice. Primary care providers approved to participate in the trial may be included on the list of approved locations under the relevant Commonwealth section 19(2) exemption arrangements: https://www.legislation.gov.au/F2026N00563/asmade/text.

If you do not provide all or part of the information requested, we may not be able to progress your participation in the trial.

We use the services of Snapforms to administer this form. Information collected through this form is hosted in Australia and managed in accordance with Snapforms' data hosting and security arrangements.

Is your practice located in a Modified Monash Model 2-7 area of Victoria? *

YesNo

TIP: You can find your practice’s Modified Monash Model classification here: https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator

Are you accredited for GP training with Australian College Rural and Remote Medicine (ACRRM) or Royal Australian College of General Practitioner (RACGP) to be a GP Registrar Training Practice and GP Supervisor? *

YesNo

How interested are you in participating in Victoria's SEM trial by hosting a SEM trainee *

I would like to register my details and apply for a Section 19(2) exemption nowI’m interested and would like to learn moreI'm not interested at this time

Please enter your details to apply for the Section 19(2) exemption, allowing you to continue to bill the Medicare Benefits Schedule (MBS) via the revenue generated from the SEM trainee

Your business name

Your current legal entity name

Modified Monash Model (MMM) location

ABN

Practice Address

Street address

Town

State

Postcode

I agree to the Victorian Department of Health submitting my practice name, legal entity name, ABN, MMM location and street address to the Australian Government Department of Health and Aged Care to process a Section 19 (2) exemption.

AgreeDo not Agree

Your agreement is required to submit an application for 19(2) exemption.

Please enter your contact details.

Email Address

Phone Number

I agree to be contacted by the Victorian Rural Generalist Program team regarding the outcome of my 19(2) application and with information I need to participate in the SEM trial.

AgreeDo not Agree

Your agreement is required to submit an application for 19(2) exemption.

Enter your email address below to receive updates from the Victorian Department of Health regarding the SEM trial and how you can register for a Section 19(2) exemption.

Practice Name

Email Address

Thank you for your time. The Single Employer Model trial is for primary care providers in rural and regional Victoria.

Thank you for your time. Further information is available on the Department of Health website if you are interested in participating in the future.

Thank you for your interest.

A member of the Victorian Rural Generalist Program team will be in touch with updates.

If you have any questions or need to update your application, please don't hesitate to contact us at singleemployermodel@health.vic.gov.au