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, your solicitor 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 use assistive technology because of a disability or impairment we provide help for assistive technology users of forms.

Page last updated: 27 August 2017