IQ Radiology Request Image Access Account Application Request image Access To apply for an account, please complete the application form. Our PACS team will review your application and once approved you will receive a confirmation email. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Title *Dr.Prof.Mr.Ms.Mrs.MissOtherName *FirstLastProfession *General PractitionerSpecialistAllied HealthDentalNurse PractitionerEndorsed MidwifeRegistrarExternal PACS AdminRegistered NurseSpecialty *AllergyAnesthesiologyBreastCardiac/ CardiologyDermatologyEmergencyEndocrinologyENTGastrointestinalGeneral MedicineGeneral SurgeryGeriatricsHaematologyNeurology/ NeurosurgeryObstetrics and GynaecologyOncologyOral MaxillofacialOrthopaedicsPathologyPaediatricsPlastic SurgerySports & Exercise Medicine PhysicianRadiation OncologyRadiologyRespiratoryRheumatologyUrologyEmail *Phone *Name of Clinic/ Practice/ Hospital *Provider Number *AHPRA Number *Address of Clinic/ Practice/ Hospital *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryAdditional Information *Terms of Service *I have read and agree to the Terms of Service Agreement listed belowI agree with IQ Radiology as follows: I will treat the confidential information as confidential. I will only access and use the confidential information to the extent necessary for the 'reason for access' nominated above. I will not disclose or make available the confidential information to another person, except an officer, employee or adviser of my Organisation to the extent necessary for the 'reason for access' nominated above. I will take all reasonable steps to preserve the privacy and confidentiality of the confidential information. Nothing in this Agreement gives me any proprietary or other rights to the confidential information, either expressly or by implication. I will keep the confidential information secure and protected from any use, disclosure or access which is inconsistent with this Agreement. I will comply with the Privacy Act 1 988 and all laws and IQ Radiology policies which protect the privacy, confidentiality or security of the confidential information. I will promptly notify IQ Radiology if I suspect, or become aware of, any actual or potential loss, unauthorised access, use, storage, copying or disclosure of the confidential information. I will promptly co-operate with IQ Radiology in relation to any audit, review or incident response relating to the privacy, confidentiality and security of the confidential information. I will on request from IQ Radiology immediately destroy, permanently delete or return the confidential information to IQ Radiology as directed by IQ Radiology. Where I disclose or make available the confidential information to another person ('recipient'), I must ensure that each recipient strictly observes all of my obligations under this Agreement as if those obligations were imposed on the recipient. I must not disclose my log in password to any other party and agree to be responsible for any PACS/RIS access under my login and any consequences of that access. I am aware that IQ Radiology is able to track all activity in relation to access to data on PACS/RIS. I agree that IQ Radiology may suspend, disable, block or terminate my access to PACS/RIS immediately for breach of this Agreement or for any other reason. I warrant to IQ Radiology that I have the authority to enter into this Agreement, both on my own behalf as an individual, and where applicable on behalf of the Organisation nominated above (as though the terms "I", "me" and "my" also apply to that Organisation). If any provision of this Agreement is invalid under the law of any jurisdiction, that provision is enforceable in that jurisdiction to the extent that it is not invalid. If IQ Radiology fails to enforce any of its rights under this Agreement, that does not mean IQ Radiology waives those rights. If I fail to enforce any of my rights under this Agreement, that does not mean I waive those rights. This Agreement is binding on IQ Radiology and me if I accept this Agreement by clicking 'I agree' above, and IQ Radiology grants me access to its PACS or RIS system (or both). I understand that I may print or save a copy of this page for my records of this Agreement. This Agreement continues without limitation in time in respect of confidential information acquired prior to termination of my access to PACS/RIS. Submit