Health professionals forms by code

Forms listed by code for health professionals, practice staff and pharmacy assistants.

Codesort descending Title
2014 Application for registering a dental speciality
2960 Application for a Medicare provider number and/or Pharmaceutical Benefits Scheme prescriber number for a midwife or nurse practitioner
3124 Request to remove your name from Medicare Australia's Vocational Register of General Practitioners
3124(ACT) Request to remove your name from Medicare Australia's list of Recognised Fellows
3301 Application for an initial Medicare provider/registration number for a Dentist, Dental Specialist or Dental Prosthetist
8109 Practice Nurse Incentive Program - Practice Ownership Details and Declaration
AC003 Aged Care approved provider statement
AC004 Register or amend for Aged Care Online Claiming using Web Forms
AC005 Change of nominated user's details for Aged Care Online Claiming
AC006 Register or amend for Aged Care Online Claiming using File Upload or Business to Business
AC007 Terms and Conditions for Aged Care Online Claiming using web forms
AC008 Terms and Conditions for Aged Care Online Claiming using File Upload or Business to Business
AC009 Register or Amend Access for Aged Care Online Claiming Viewing Electronic Aged Care Client Records
AC010 Consent to release an electronic Aged Care Client Record
AC011 Application for the Oxygen and/or Enteral Feeding Supplement
AC012 Aged Care Application for an Extension of Transition Care
AC013 Aged Care home care packages transfer level of care for Aged Care recipients
AC014 Aged Care Application for the Dementia and Cognition Supplement in Home Care
AC015 Application to add or change Approved Care Service's bank details
AC021 Aged Care Entry Record
DB018 Application for bulk bill claim adjustment
DB020 Assignment of Benefit Medicare Bulk Bill Webclaim
DB1-DP Allied Health Chronic Disease Dental Scheme Header
DB1-DP-I Bulk bill instruction sheet Dental Practitioner only
DB1H In Hospital Service Header
DB1H(i) Bulk bill instruction sheet In-Hospital Services only
DB1N Out of Hospital Services Header
DB1N(i) Bulk bill instruction sheet Out of Hospital Services only
DB1N-AH Allied Health Header
DB1N-AH(i) Bulk bill instruction sheet Allied Health Professional only
DB1N-DB Dental Provider Header
DB1N-DB(i) Instruction Sheet Dental Provider only
DB2-AH Allied Health Professional Voucher
DB2-AH(i) Assignment form instruction sheet Allied Health Professional only
DB2-DB Dental Provider Voucher
DB2-DB(i) Instruction sheet Dental Provider only
DB2-DP Allied Health Chronic Disease Dental Scheme (assignment of benefit) Voucher
DB2-DP Assignment form instruction sheet Dental Practitioner only
DB2-GP General Practitioner Voucher
DB2-GP(i) Assignment form instruction sheet General Practitioner only
DB2-OP Optometrist (assignment of benefit) Voucher
DB2-OP(i) Assignment form instruction sheet Optometrist only
DB2-OT Other Practitioner Voucher
DB2-OT(i) Assignment form instruction sheet Other Practitioner only
DB3 Pathologist (assignment of benefit) Voucher
DB3(i) Assignment form instruction sheet Pathologists only
DB4 General, Specialist and Diagnostic (assignment of benefit) Voucher
DB4(i) Assignment form instruction sheet General, Specialist and Diagnostic Practitioner only
DB4E Electronically Transmitted claims (assignment of benefit) Voucher
DB6Ba Medicare stationery order
DBM(i) Manual Bulk Bill Forms Information sheet
HW001 Application for a Public Key Infrastructure Site Certificate
HW002 Application for a Public Key Infrastructure Individual Certificate
HW003 Request to Revoke or Reissue a Public Key Infrastructure Certificate
HW004 Acceptable Referee Declaration Public Key Infrastructure Certificate applications
HW009 Approved Pathology Practitioner application
HW010 Application for approval of premises as an Accredited Pathology Laboratory
HW011 Approved Pathology Authority application
HW012 Healthcare Identifiers Service - My Health Record system - Application to register a Contracted Service Provider organisation record
HW013 Healthcare Identifiers Service - Application to register a General Supporting Organisation
HW015 Application to register as an Approved Billing Agent and ECLIPSE
HW018 Healthcare Identifiers Service - My Health Record system - Application to Register a Seed Organisation
HW019 Application for an initial Medicare provider number for a medical practitioner
HW020 Application for an additional location provider number for an Allied Health Professional
HW021 Application to request a NASH PKI Certificate for Healthcare Provider Organisations
HW022 Application to request a NASH PKI Certificate for Individual Healthcare Providers
HW023 Simplified Billing or ECLIPSE adjustment claim
HW025 Hospital or Day Procedure Centre Registration for In Hospital Claiming
HW026 Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits
HW027 Online Claiming Provider Agreement
HW029 Provider registration for Electronic Funds Transfer payments
HW031 National Authentication Service for Health Public Key Infrastructure Certificate for Individual Healthcare Providers Terms and Conditions of Use
HW033 Healthcare Identifiers Service - Application to register a Healthcare Provider
HW034 Healthcare Identifiers Service - Application to Amend a Healthcare Provider Record
HW035 Application or cancellation of an Approved Collection Centre
HW036 Approved Pathology Authority acquisition or merger advice
HW037 Healthcare Identifiers Service - Application to amend a Healthcare Organisation record
HW038 Unable to transmit Medicare Two-way claim
HW040 Healthcare Identifiers Service - Application to replace a Responsible Officer or add or remove an Organisation Maintenance Officer for an Organisation
HW041 Healthcare Identifiers Service - Application to register a Network Organisation
HW042 Healthcare Identifiers Service - Application to Amend an Organisation Officer's Personal Details
HW043 Healthcare Identifiers Service - Application to amend details of a Contracted Service Provider organisation record
HW044 Healthcare Identifiers Service Application to deactivate, reactivate or retire a healthcare organisation
HW045 Healthcare Identifiers Service - Application to request or link a Public Key Infrastructure certificate
HW046 Healthcare Identifiers Service - Application to add, replace or remove a Contracted Service Provider officer
HW047 Healthcare Identifiers Service Application to amend a Contracted Service Provider officer's details
HW048 Healthcare Identifiers Service Application to deactivate or retire a Contracted Service Provider organisation
HW050 National Authentication Service for Health Public Key Infrastructure Certificate for Healthcare Provider Organisations - Terms and Conditions of Use
HW052 Banking Details Online Claiming
HW053 Approved Collection Centres renewal
HW055 Notification of Australian Business Number and reference identification for tax treatment purposes and Recipient Created Tax Invoice agreement
HW058 Approved Billing Agent Simplified Billing Assignment Claim
HW059 Medicare Easyclaim enquiry
HW060 Application for certification of eligibility for Vocational Registration of General Practitioners
HW061 Registration for a Location Specific Practice Number
HW062 Application for an additional location Medicare provider number for a medical practitioner
HW063 Application for an initial Medicare provider / registration number for an Allied Health Professional
HW064 Positron Emission Tomography - Statutory Declaration
HW065 Application for Remote Area Exemption for 'R Type' Diagnostic Imaging Services for Medical Practitioner
HW072 Request to amend Location Specific Practice Number
HW073 Application for a Medicare provider/registration number for an orthoptist
HW074 General Practitioner 90 Day Pay Doctor Cheque Scheme Application
HW075 Application for recognition as a General Practitioner Fellows of the Royal Australian College of General Practitioners
HW076 Application for recognition as a General Practitioner Fellow of the Australian College of Rural and Remote Medicine
HW077 Application for recognition as a Specialist or Consultant Physician
HW078 Request for Pay Group Link
HW079 Application for an initial Medicare provider/registration number for an Optometrist
HW080 Manual identity verification for Provider Digital Access
HW081 Private health insurer registrations and updates for ECLIPSE
HW083 Request to revoke or reissue a National Authentication Service for Health Public Key Infrastructure Certificate
IM001 Australian Childhood Immunisation Register (ACIR) - Immunisation encounter header
IM002 Australian Childhood Immunisation Register - Immunisation encounter
IM003 Immunisation stationery order for NSW VIC SA WA TAS ACT
IM004 Australian Childhood Immunisation Register (ACIR) - Application to Register as a Vaccination Provider
IM005 Australian Childhood Immunisation Register - Bank account details for a vaccination providers
IM006 Immunisation stationery order for QLD and NT
IM011 Australian Childhood Immunisation Register (ACIR) - Immunisation medical exemption
IM013 Australian Childhood Immunisation Register immunisation history
IP001 Practice Incentives Program application
IP003 Practice Incentives Individual general practitioner or nurse practitioner details
IP004 Practice Incentives Program Cervical Screening, Asthma and Diabetes Incentives application
IP005 Practice Incentives Change of practice details
IP006 Practice Incentives Program Teaching Payment claim
IP007 Practice Incentives - Practice closure or withdrawal
IP008 Practice Incentives Programme - Practice ownership details
IP009 Practice Incentives Programme Indigenous Health Incentive practice register authority
IP010 Practice Incentives Change of practice ownership
IP011 Practice Incentives Programme Service Incentive Payments banking details
IP017 Practice Incentives Program Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Patient Registration and Consent
IP018 Practice Incentives Change of authorised contact person(s)
IP019 Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure - Multiple patient registration and consent
IP020 General Practice Rural Incentives Program Bank account details
IP025 Practice Incentives Programme Additional practice branch
IP026 Practice Incentives Program Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-payment Measure Practice application
IP027 Practice Incentives Review of decision
IP028 Practice Nurse Incentive Programme application
IP029 Practice Incentives Programme Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-payment Measure Patient withdrawal of consent
IP030 Practice Incentives Programme After Hours Incentive application
MO001 Private Health insurer registration for electronic transmission and Electronic Funds Transfer
MO003 Provider Directory Data authorised recipient data release application or renewal
MO004 Run off Cover Indemnity Scheme Medical Indemnity payment application
MO005 Information you need to know about your Run-off Cover Indemnity Scheme Medical Indemnity payment application
MO006 Information you need to know about your Medical Indemnity refund application
MO007 Medical Indemnity refund application
MO008 Medical Indemnity Request to aggregate payments for the same claim
MO009 Incurred-But-Not-Reported Indemnity Scheme Medical Indemnity payment application
MO010 Information you need to know about your Incurred-But-Not Reported Indemnity Scheme medical Indemnity payment application
MO011 Information you need to know about your High Cost Claim Indemnity Scheme Medical Indemnity payment application
MO012 High Cost Claim Indemnity Scheme Medical Indemnity payment application
MO020 Compliance Audit - Exceptional Circumstances - Statutory Declaration
MO031 Statutory Declaration Run-off Cover Indemnity Scheme – Medical practitioner aged 65 years of age or over who has ceased either private or all remunerated medical practice
MO032 Run-off Cover Indemnity Scheme – for Medical Practitioners – Medical Certificate maternity or permanent disability
MO033 Statutory Declaration Run-off Cover Indemnity Scheme – Deceased medical practitioner
MO034 Statutory Declaration Run-off Cover Indemnity Scheme – Medical practitioner who has not engaged in either private or remunerated medical practice during the preceding 3 years
MO035 Statutory Declaration Run-off Cover Indemnity Scheme – Overseas medical practitioner
MO036 Statutory Declaration Run-off Cover Indemnity Scheme – Medical practitioner who has ceased medical practice because of permanent disability
MO037 Run-off Cover Indemnity Scheme - Medical practitioner who has ceased medical practice because of maternity
MO038 Statutory Declaration - Run-off Cover Indemnity Scheme - Midwife who has ceased practice because of permanent disability
MO039 Statutory Declaration Run-off Cover Indemnity Scheme - Midwife aged 65 years of age or over who has ceased practice
MO040 Statutory Declaration Run-off Cover Indemnity Scheme – Deceased Midwife
MO041 Statutory Declaration Run-off Cover Indemnity Scheme - Midwife who has ceased practice
MO042 Statutory Declaration Midwife Professional Indemnity Scheme – Online claim
MO043 Run-off Cover Indemnity Scheme for Midwife Medical Certificate for maternity or permanent disability
MO044 Statutory Declaration Run-off Cover Indemnity Scheme - Midwife engaged in a private practice
MO046 Medical Indemnity Run-off Cover Indemnity Scheme (ROCS) protocol payments application package
MS002 Voluntary acknowledgement of incorrect payments
PB008 Applying for Approval Change of Ownership of a Pharmacy (not involving relocation)
PB009 Applying for Approval to Supply Pharmaceutical Benefits at a Particular Premises
PB010 Online Claiming for Pharmaceutical Benefits Scheme - Application and Terms and Conditions
PB011 Pharmaceutical Benefits Scheme Receipt - S.87A, National Health Act 1953
PB012 Myelodysplastic syndrome Initial PBS authority application and supporting information
PB019 Notification of Bank Account Details for Aboriginal Health Services program payments
PB020 Order for PBS/RPBS personalised standard prescription books for Medical Practitioners
PB022 Order for PBS/RPBS personalised computer prescription forms for Medical Practitioners
PB024 Order for PBS/RPBS personalised authority prescription books for Medical Practitioners
PB026 Order for PBS/RPBS personalised prescription books for Dental Practitioners
PB028 Order for PBS/RPBS personalised prescription books for Optometrists
PB030 Order for PBS/RPBS personalised computer prescription forms for Optometrists
PB032 Order for PBS/RPBS personalised computer prescription forms for Nurse Practitioners and Midwives
PB034 Order for PBS/RPBS personalised authority prescription books for Nurse Practitioners and Midwives
PB036 Order for PBS/RPBS personalised prescription books for Nurse Practitioners and Midwives
PB042 Aboriginal Health Services (AHS) pharmaceutical supplies request
PB048 Notification of bank account details for an Approved Community Pharmacy
PB049 Stoma Appliance Scheme Application
PB050 Application for additional stoma supplies
PB057 Gastrointestinal stromal tumour – adjuvant Initial PBS authority application Supporting information
PB060 Juvenile idiopathic arthritis Initial PBS authority application Supporting information
PB061 Juvenile idiopathic arthritis Continuing PBS authority application Supporting information
PB062 Juvenile idiopathic arthritis for adult patients with onset prior to age 18 Initial PBS authority application Supporting information
PB063 Juvenile idiopathic arthritis for adult patients with onset prior to age 18 Continuing PBS authority application Supporting information
PB065 Sapropterin for BH4 deficiency Initial and continuing PBS authority application Supporting information
PB070 Pulmonary arterial hypertension Initial PBS authority application Supporting information
PB071 Pulmonary arterial hypertension Continuing PBS authority application Supporting information
PB072 Subfoveal choroidal neovascularisation Initial PBS authority application Supporting information
PB073 Ankylosing spondylitis Initial PBS authority application Supporting information
PB074 Ankylosing spondylitis Continuing PBS authority application Supporting information
PB075 Severe allergic asthma Initial PBS authority application and Supporting information
PB076 Severe allergic asthma Continuing PBS authority application and Supporting information
PB077 Acute Lymphoblastic Leukaemia – dasatinib Initial PBS authority application
PB078 Acute Lymphoblastic Leukaemia – imatinib mesylate Initial PBS authority application
PB079 Azacitidine Initial PBS authority application
PB082 Chronic myeloid leukaemia Initial PBS authority application Imatinib mesylate, accelerated or blast phase application Supporting information
PB083 Chronic myeloid leukaemia, chronic phase Initial PBS authority application Supporting information
PB084 Chronic myeloid leukaemia Continuing PBS authority application Supporting information
PB085 Crohn disease Initial paediatric PBS authority application and Supporting information
PB087 Crohn disease Initial PBS authority application and Supporting information
PB088 Crohn disease Continuing PBS authority application and Supporting information
PB090 Paediatric Crohn's disease Activity Index
PB091 Adult Crohn's Disease Activity Index
PB092 Fistulising Crohn disease Initial PBS authority application and Supporting information
PB093 Fistulising Crohn's Disease Continuing PBS authority application Supporting information
PB094 Early breast cancer Initial PBS authority application Supporting information
PB095 Gastrointestinal stromal tumour – metastatic or unresectable Initial PBS authority application Supporting information
PB096 Sunitinib malate Gastrointestinal stromal tumour PBS authority application
PB097 Idiopathic thrombocytopenic purpura Initial PBS authority application and Supporting information
PB098 Idiopathic thrombocytopenic purpura Continuing PBS authority application Supporting information
PB099 Metastatic breast cancer Initial PBS authority application and Supporting information
PB102 Multiple myeloma – bortezomib Continuing PBS authority application Supporting information
PB103 Multiple myeloma - bortezomib Initial PBS authority application Supporting information
PB104 Narcolepsy Initial PBS authority application and Supporting information
PB105 Psoriatic arthritis Initial PBS authority application Supporting information
PB106 Psoriatic arthritis Continuing PBS authority application and Supporting information
PB107 Rare diseases imatinib mesylate Initial PBS authority application Supporting information
PB108 Rare diseases imatinib mesylate Continuing PBS authority application Supporting information
PB109 Rheumatoid arthritis Initial PBS authority application and Supporting information
PB110 Rheumatoid arthritis Initial PBS 'grandfather' authority application and Supporting information
PB111 Rheumatoid arthritis Continuing PBS authority application and Supporting information
PB112 Severe chronic plaque psoriasis Initial PBS authority application and supporting information
PB113 Severe chronic plaque psoriasis Continuing PBS authority application
PB114 PASI calculation and body diagram - face, hand and foot
PB115 PASI calculation and body diagram - whole body
PB116 Severe chronic plaque psoriasis for patients under 18 years Initial PBS authority information Supporting information
PB117 Systemic Juvenile idiopathic arthritis Initial PBS authority application Supporting information
PB118 Systemic Juvenile idiopathic arthritis Continuing PBS authority application Supporting information
PB119 Atypical Haemolytic Uraemic Syndrome (aHUS) - eculizumab Initial PBS authority application Supporting information
PB120 Cystic Fibrosis - Ivacaftor - Initial PBS authority application Supporting application
PB121 Alzheimer disease PBS Initial authority application
PB122 Chronic myeloid leukaemia Second and Third line initial PBS authority application Supporting information
PB123 Brentuximab vedotin - CD30 positive systemic anaplastic large cell lymphoma Initial PBS authority application Supporting information
PB125 Atypical Haemolytic Uraemic Syndrome (aHUS) - eculizumab Continuing PBS authority application Supporting information
PB126 Cystic Fibrosis - Ivacaftor - Continuing PBS authority application Supporting information
PB127 Ulcerative colitis (moderate to severe) PBS subsidised authority application Supporting information
PB131 Prescription Shopping Information Service registration
PB132 Patient claim for refund Pharmaceutical Benefits Scheme (PBS)
PB133 Application for a medical practitioner to supply pharmaceutical benefits
PB134 Application for a hospital authority to supply pharmaceutical benefits and/or highly specialised drugs
PB135 Authority for authorised pharmacist(s) to sign claim forms on behalf of Approved Pharmacist(s)
PB136 Seemingly valid Medicare card
PB138 Authority for Authorised Pharmacist(s) to sign claim forms on behalf of Section 91 Permission Holder
PB140 Application for temporary approval to supply pharmaceutical benefits by a registered medical practitioner
PB141 Notification of bank account details for a hospital authority
PB142 Authority for Authorised Person(s) to sign claim forms on behalf of a hospital authority
PB143 Imatinib mesylate (Glivec) - Blast phase Initial PBS authority application Supporting information
PB150 Application for approval to prescribe medications under the Pharmaceutical Benefits Scheme by a registered medical practitioner
PB151 Application for approval to prescribe medications under the Pharmaceutical Benefits Scheme (PBS) by a registered dental practitioner
PB152 Application for approval to prescribe medication under the Pharmaceutical Benefit Scheme (PBS) as an authorised optometrist
PB154 Retinal Vein Occlusion Initial PBS authority application Supporting information
PB155 Diabetic Macular Oedema Initial PBS authority application Supporting information
PB156 ALK-Positive Non-Small Cell Lung Cancer Initial and continuing PBS authority application Supporting information
PB157 Request for Prescriber bag supplies order book
PB158 Multiple Myeloma - lenalidomide and pomalidomide Initial PBS authority application Supporting information
PB159 Chronic Lymphocytic Leukaemia Initial PBS authority application Supporting information
PB161 Crohn disease Continuing paediatric PBS authority application Supporting information
PB162 Growth Hormone Initial PBS authority application Supporting information
PB163 Growth Hormone Continuing PBS authority application Supporting information
PB164 Growth Hormone Continuing as a reclassified patient PBS authority application Supporting information
PB165 Growth Hormone Recommencement PBS authority application Supporting information
PB166 Growth Hormone Recommencement as a reclassified patient PBS authority application Supporting information
PB169 Acute Lymphoblastic Leukaemia Ponatinib - Initial PBS Authority application Supporting information
PB171 Chronic myeloid leukaemia Ponatinib - Initial PBS authority application Supporting information
PB172 Myelofibrosis Initial PBS Authority application
PB173 Metastatic stage IV HER2 positive adenocarcinoma of the stomach or gastro-oesophageal junction Initial PBS Authority application Supporting information
PB174 Severe active granulomatosis with polyangiitis or severe active microscopic polyangiitis Initial PBS Authority application Supporting information
PB175 Atypical Haemolytic Uraemic Syndrome (aHUS) eculizumab Extended initial PBS authority application Supporting information
PB176 Atypical Haemolytic Uraemic Syndrome (aHUS) eculizumab Recommencement PBS authority application Supporting information
PB178 Change of pharmacy trading name
PB179 Arrange return of PBS stationery for secure destruction
SU415 Medical Certificate

This information was printed Thursday 28 July 2016 from humanservices.gov.au/health-professionals/forms/forms-by-code 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.