Instructions for Health Service Provider Institution Representative Certification





(Advice as at February 2018)


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


King Edward Memorial Hospital

TBA, Director of Clinical Services



Dr Silvano Palladino, Executive Director


Princess Margaret Hospital

Dr Mark Salmon, Executive Director Medical Services


Royal Perth Hospital

Dr Aresh Anwar, Executive Director


Sir Charles Gairdner Hospital

Tony Dolan, A/Executive Director