Please note this form does not have a save function and needs to be fully completed in one session. Privacy notice NHMRC collects personal information from guideline developers seeking NHMRC approval of their guideline as part of the guideline registration process. This personal information is being collected so that NHMRC can communicate with you about your registration and to assess your application. If you do not provide this information, we may not be able to consider your registration. By providing this information, you are acknowledging that your personal information collected via this website will be stored and used in accordance with NHMRC’s obligations under the Privacy Act 1988, and in accordance with the NHMRC Privacy Policy. Guideline Scope Guideline title Name of guideline developer Needs analysis Please address the questions listed in the Needs analysis template and include supporting references. Population lifestage? Tick all that apply Infant, Newborn (>1 Month) Infant (1-23 Months) Child (2-12 Years) Adolescent (13-18 Years) Adult (19-64 Years) Adult, Aged (65+ Years) What level of use is this guideline being developed? Tick all that apply National International State Health Service Local Hospital Australia and New Zealand Asia Pacific Other… Specify Select the healthcare setting that your guideline will be applied Tick all that apply Emergency care Residential Preventative Care Primary/Community Care Secondary Care Tertiary Care All care settings Indicate the status of your guideline Indicate the status of your guideline - Select -New guidelineReplacement guidelineGuideline updateOther… Specify What is your proposed start date? What is your proposed end date? Who is funding your guideline? What is the funding status of your guideline? What is the funding status of your guideline? - Select -Have secured fundingHave applied for fundingWill be seeking fundingWill not be seeking fundingOther… Specify Specify the source of secured funding As 'Have secured funding' has been selected, the funding source must be specified here: Additional comments on funding Organisation and Contact Information List all organisations developing the guideline Is there any supporting information you would like to provide? Nominate a contact person Name Company Email Phone Address Address 2 City/Town State - None -Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postal Code Country AustraliaAustraliaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta and MelillaChadChileChinaChristmas IslandClipperton IslandCocos [Keeling] IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau SAR ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar [Burma]NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaSão Tomé and PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Submit Leave this field blank