Medicare Compensation Recovery Medicare history statement request form (MO026)

Use this form to get a copy of your Medicare history statement, to find out what benefits and subsidies need to be repaid to us as per a Notice of past benefits.

You, an authorised third party or the person paying your compensation can request a copy of your statement. This form is the first step in requesting a Notice of past benefits under Section 21 of the Health and Other Services (Compensation) Act 1995.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 3 December 2019