Claim for External Breast Prostheses Reimbursement Program form (NH005)

Use this form to claim a reimbursement for new or replacement breast prostheses you purchased since 1 July 2008, as a result of breast cancer.

All Medicare benefits are paid directly into your nominated bank account. Register your bank account details with us when completing this form to make sure you don’t miss out on receiving your Medicare benefit.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
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Page last updated: 14 October 2016

This information was printed Saturday 10 December 2016 from humanservices.gov.au/customer/forms/nh005 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.