Medical Practice Information Transfer (MPIT) Form

The Medical Practice Information Transfer (MPIT) Form is designed to support the appropriate transfer of information about a doctor’s practice to and from the doctor’s responsible officer. It can be used to share information with the doctor’s responsible officer in the following situations:

  • when a doctor’s prescribed connection changes
  • when a concern arises about the doctor’s practice in any place where the doctor is practising

It may also have a role in providing routine information about the doctor’s practice.

Using the form

Instructions for using the form are provided within the form itself. Users can access these by clicking on the information buttons throughout.

Please refer to your organisation’s information governance policy when sharing of information and documents about doctors with other organisations.

Please save the form first, before attempting to complete it, to ensure it operates and functions correctly.

You will require Adobe Acrobat Reader to view and complete this form.

If you experience any problems opening the form directly via the above link, or you receive a ‘Please wait…’ error message, then right click on the above link, select ‘Save as…’ or ‘Save target as…’ or ‘Save link as…’ and save the file in your chosen folder/location. Then open the form from the saved folder/location.