eHealth+ Connectivity Support Scheme (the Support Scheme)
Application Form


(Part 1) Information of the Applicant

Healthcare provider name * :
eHealth HCP number * :
Accredited eMRS being used * :
Name of contact person * :
Post title * :
Telephone no. * :
Email address * :

* Mandatory field

(Part 2) List of the Registered Medical Practitioner ("RMP") list under the Applicant

Name of the RMP
eHealth user account number of the RMP

Confirm Entered Information


(Part 1) Information of the Applicant

Healthcare provider name:
eHealth HCP number:
Accredited eMRS being used now:
Name of contact person:
Post title:
Telephone no.:
Email address:

(Part 2) List of the Registered Medical Practitioner ("RMP") list under the Applicant

Name of the RMP eHealth user account number of the RMP

(Part 3) Submission of Application Form

  1. that the Applicant has read and fully understands the Terms and Conditions of the Support Scheme, and the Applicant fulfills all of the relevant eligibility criteria set out therein;
  2. that the required information submitted herein is true and accurate to the best of the Applicant's knowledge;
  3. to inform the HA immediately in writing if there are any changes to the above information;
  4. in the event that any information submitted by the Applicant is found untrue, incomplete or inaccurate, the HA reserves the right to revoke the approval of any application, request refund of any sponsorship, and take other recovery actions;
  5. that the Applicant understands that any omission or misrepresentation of information with a view to obtaining any sponsorship by deception is an offence and liable to legal proceedings;
  6. to provide such additional information and/or documents as required by the HA in support of the application;
  7. that the Applicant has obtained consent from all relevant RMPs for the disclosure and use of their information/personal data for the purpose of this application;
  8. that the Applicant understands that the HA has the sole right and discretion to determine whether the Applicant is eligible for sponsorship under the Support Scheme and whether the application is successful; and
  9. that the Applicant shall comply in all respects with all applicable laws and regulations (including without limitation the Safeguarding National Security Ordinance).

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