Forms and brochures
On this Page:
- Medicare Safety Net forms and brochures
- Medicare benefit tax statement form
- Medicare claiming forms
- Medicare enrolment and card forms
- Medicare and PBS claims information application and authority forms
- Compensation Recovery Program Forms
- Immunisation Register forms and brochures
- Indigenous forms and brochures
- Australian Organ Donor Registration forms and brochures
- Federal Government 30% rebate
- PBS Patient claim for refund form
- Brochures - general
Medicare Safety Net forms and brochures
- Register online
- Medicare Safety Net registration form [PDF, 146Kb]
- Medicare Safety Net amendment form [PDF, 111Kb]
- Medicare Safety Net couples and families should register for greater savings brochure [PDF, 3.0Mb]
Medicare benefit tax statement form
Medicare claiming forms
- Medicare claim form [PDF, 204Kb] Complete this form and send together with accounts/receipts, to Medicare GPO Box 9822 in your Capital City or take to any Medicare office.
- Medicare two way form [PDF, 109Kb] Complete this form to claim Gap Benefits from your Private Health Fund for inpatient/ancillary services—Private Health Fund claims can only be lodged by members of Funds participating in a Two-Way agency Agreement with Medicare Australia. More information on Medicare Two Way.
- Medicare levy exemption certification form [PDF, 157Kb]
- Electronic Funds Transfer (EFT) details collection form [PDF, 116Kb]
Medicare enrolment and card forms
- Medicare Enrolment form [PDF, 618Kb] To be completed when enrolling in Medicare for the first time, for example a migrant or enrolling a baby. If you have been granted or have applied for a permanent visa (excluding applications for a parent visa)—your document requirements may differ. Please call Medicare on 132 011 for further information.
- Medicare Copy/Transfer Application form [PDF, 60Kb] Complete this form to copy or transfer someone on to your own Medicare card or another Medicare card. Where the transfer or copy is to another person's Medicare card that cardholder must also sign the form.
- Statutory Declaration for Enrolment
- Medicare notification of deceased person form [PDF, 210Kb]
Medicare and PBS claims information application and authority forms
Compensation Recovery Program Forms
- Compensation Recovery Electronic Funds Transfer (EFT) form [PDF, 116Kb]
- Compensation Recovery Medicare history statement request [PDF, 80Kb]
- Notice of reimbursement arrangement form [PDF, 158Kb]
- Notice of judgment/settlement form [PDF, 207Kb]
- Authority to release information form [PDF, 121Kb]
- Section 23A statement form [PDF, 210Kb]
Immunisation Register forms and brochures
- Keeping track of your child’s immunisations brochure [PDF, 401Kb]
- Your child’s immunisation history can help you brochure [PDF, 878Kb]
These forms are available from Medicare offices and your doctor or immunisation provider.
- Medical Contraindication form [PDF, 150Kb] – used when a child cannot be immunised because of a medical condition. This form must be completed by a doctor or an immunisation provider and sent to the Immunisation Register.
- Conscientious Objection form [PDF, 177Kb] – used to record a parent's personal, philosophical, religious or medical belief that immunisation should not occur. This form must be signed by a doctor or immunisation provider and sent to the Immunisation Register.
- Immunisation History form [PDF, 79Kb] – used to record a child's vaccination details that may be missing from the Immunisation Register. This form must be completed by a doctor or immunisation provider and sent to the Immunisation Register.
Note: printed copies of this form will not appear in triplicate.
Indigenous forms and brochures
- Aboriginal and Torres Strait Islander Medicare enrolment and amendment form [PDF, 484Kb]
- Voluntary Indigenous Identifier brochure (Aboriginal) [PDF, 299Kb]
- Voluntary Indigenous Identifier brochure (Torres Strait Islander) [PDF, 274Kb]
Australian Organ Donor Registration forms and brochures
- Sign on to save lives brochure [PDF, 479Kb]
- Online registration
- New Registration or Change of Details form [PDF, 130Kb]
Federal Government 30% rebate
PBS Patient claim for refund form
Brochures - general
- Medicare Australia Online Services brochure [PDF, 127Kb]
- Medicare your questions answered brochure [PDF, 638Kb]
- Our promise to you brochure [PDF, 490Kb]
- Saving you money on medicine brochure [PDF, 529Kb]
Some documents on this page may require the free Adobe PDF reader.
Last updated: 12 June, 2008