Instructions for Health Service Provider Institution Representative Certification


(Advice as at February 2019)

Certification Form Section 6 ‘Health Service Provider Institution Representative’ is to be completed by the following institutional representatives (or delegate). If your institution is not listed then please contact Amanda Cleaver (9386 9880 or for assistance.


Fiona Stanley Hospital

Dr Paul Mark, Director of Clinical Services

Graylands Hospital

Dr Viki Pascu, Director of Clinical Services

King Edward Memorial Hospital

Associate Professor Graeme Boardley, A/Executive Director


Frances Brogden, A/Deputy Executive Director

Perth Children’s Hospital

Dr Ian Gollow, A/Executive Director Medical Services

Royal Perth Hospital

Dr Lesley Bennett, Executive Director

Sir Charles Gairdner Hospital

Janet Zagari, A/Executive Director