Provider forms
Last updated:
Use these forms to arrange treatment and support services for veterans and their dependents who have DVA health cards.
Healthcare professionals seeking further information about DVA health arrangements and programs please visit the DVA providers page.
If you need assistance with DVA forms, call us on 1800 555 457.
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Displaying 161 forms| Form ID | Title | Audience |
|---|---|---|
| D9353 | D9353 Activities of daily living assessment | For providers, Occupational therapist (general) |
| D9076 | D9076 Acute Care Certificate | For providers, Hospitals & day procedure centres |
| D9418 | D9418 ADLs/Functional Impact - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9500 | D9500 Aggravation(s) - (DRCA/MRCA/VEA) | Compensation, For providers |
| D0695 | D0695 Allied health time based voucher | For providers, Chiropractor, Diabetes educator, Dietitian, Exercise physiologist, Medical specialist, Neuropsychologist, Occupational therapist (general), Occupational therapist (mental health), Optometrist, Orthoptist and Optical dispenser, Orthotist, Osteopath, Physiotherapist, Podiatrist/Footwear prescriber, Psychologist, Social worker (general), Social worker (mental health), Speech pathologist |
| D9457 | D9457 Aneurysms and Intra-vascular Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9474 | D9474 Ankle Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9432 | D9432 Ankle Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D1004 | D1004 Application for Community Nursing Exceptional Case Status | For providers, Community nursing, Registered Nurse |
| D9208 | D9208 Application for Licence to Reproduce Department of Veterans' Affairs Card Images | For providers, Pharmacist |
| D9173 | D9173 Application to list or modify price of a product on the RSPB | For providers, Pharmacist |
| D1004A | D1004A Attachment 1 Exceptional Case – Dementia / Short Term Memory Loss / Confusion | For providers, Community nursing, General |
| D1004B | D1004B Attachment 2 Exceptional Case — Mental Health | For providers, Community nursing |
| D1004C | D1004C Attachment 3 Exceptional Case — Palliative Care | For providers, Community nursing |
| D1004D | D1004D Attachment 4 Exceptional Case — Wound Care | For providers, Community nursing |
| D9398 | D9398 Audiology prior financial approval request | For providers, Audiologist, Audiometrist, Otolaryngologist |
| D9429 | D9429 Breast Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9453 | D9453 Cardiac Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9492 | D9492 Cardiorespiratory Effort Tolerance - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9452 | D9452 Cardiorespiratory Effort Tolerance - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9480 | D9480 Cervical Spine Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9441 | D9441 Cervical Spine Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9294 | D9294 Chiropractic/Osteopathy/Physiotherapy Prior Financial Approval Request | For providers, Chiropractor, Osteopath, Physiotherapist |
| D9401 | D9401 Claim for assistance dog expenses | General, For providers |
| D1217CN | D1217CN Claim for Treatment Services - Community Nursing | For providers, Community nursing |
| D1217 | D1217 Claim for treatment services voucher | General, For providers, Chiropractor, Clinical psychologist, Dental prosthetist, Dental specialist, Dentist, Diabetes educator, Dietitian, Exercise physiologist, General Practitioner, Hospitals & day procedure centres, Medical specialist, Neuropsychologist, Occupational therapist (general), Optometrist, Orthoptist and Optical dispenser, Orthotist, Osteopath, Physiotherapist, Podiatrist/Footwear prescriber, Psychologist, Social worker (mental health), Speech pathologist |
| D9389 | D9389 Community Nursing Referral | For providers |
| D1083 | D1083 Community Nursing Service Voucher | For providers, Community nursing |
| D6345 | D6345 Coronary Care Patient Certificate | Registered Nurse, For providers, Hospitals & day procedure centres, Medical specialist |
| D9430 | D9430 Cranial Nerves - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D0804 | D0804 D0804 - Home Medical Oxygen Therapy and/or Respiratory Home Therapy Appliances form | For providers, General Practitioner, Hospitals & day procedure centres, Medical specialist, Physiotherapist, Registered Nurse |
| D0904 | D0904 D0904 - DVA request/referral voucher | For providers, General Practitioner |
| D0988 | D0988 D0988 – Continence direct order form | For providers, General Practitioner, Medical specialist, Occupational therapist (general), Occupational therapist (mental health), Physiotherapist, Registered Nurse |
| D0992 | D0992 D0992 - Mobility Functional Support (MFS) products order form | For providers, General Practitioner, Hospitals & day procedure centres, Medical specialist, Occupational therapist (general), Physiotherapist, Rehabilitation service provider, Registered Nurse, Exercise physiologist, Podiatrist, Orthotist, Prosthetist |
| D1323 | D1323 D1323 - Authority to Install/Modify - Home/Access Modifications | For providers, Occupational therapist (general) |
| D1325 | D1325 D1325 - Electric Mobility Aids - Part 2 - Assessment | For providers, Occupational therapist (general) |
| D1327 | D1327 D1327 – Complex Home/Access Modifications | For providers, Occupational therapist (general) |
| D1382 | D1382 D1382 - Request for assistive communication device and/or speech pathology apps/software | For providers, Medical specialist, Speech pathologist |
| D9140 | D9140 D9140 - Application for Positive Airways Pressure (PAP) Equipment | For providers, Hospitals & day procedure centres, Medical specialist |
| D9160 | D9160 D9160 - Request for Trial of Equipment (Exercise Bike/Knee Scooter) - 3 Months Only | For providers, Chiropractor, Exercise physiologist, General Practitioner, Medical specialist, Osteopath, Physiotherapist |
| D9199 | D9199 D9199 - Assessment form for the supply of a Personal Response System | For providers, General Practitioner, Medical specialist, Occupational therapist (general), Physiotherapist, Registered Nurse |
| D9257 | D9257 D9257 - Order form for low vision products | For providers, Hospitals & day procedure centres, Medical specialist, Occupational therapist (general), Optometrist, Orthoptist and Optical dispenser, Registered Nurse |
| D9299 | D9299 D9299 - Post Home Modification Report | For providers, Occupational therapist (general) |
| D9300 | D9300 D9300 - Electric Mobility Aids - Part 1 - Medical Assessment | For providers, General Practitioner |
| D9356 | D9356 D9356 - Request for an assistance dog | For providers, Clinical psychologist, Medical specialist, Neuropsychologist, Occupational therapist (general), Occupational therapist (mental health), Psychologist, Social worker (mental health) |
| D9376 | D9376 D9376 - Request for assistive listening devices and/or tinnitus devices | For providers, Audiologist, General Practitioner, Hospitals & day procedure centres, Rehabilitation service provider, General |
| D9379 | D9379 D9379 - Electric Mobility Aids - Part 3 - Trial | For providers, Occupational therapist (general) |
| D9381 | D9381 D9381 - Authority to Install/Modify - Vehicle Modifications | For providers, Occupational therapist (general) |
| D9414 | D9414 D9414 - Order Form Diabetes Products | General Practitioner, Diabetes educator, Diabetes Clinic, Endocrinologist, Registered Nurse, Specialist (includes all medical specialists in relevant field), For providers |
| D9517 | D9517 D9517 - Driver Assessment and Training / Vehicle Modifications - Medical Information Form | For providers, Occupational therapist (general), General Practitioner, Local Medical Officer |
| D0919 | D0919 Dental report and voucher | For providers, Dental prosthetist, Dental specialist, Dentist |
| D0986 | D0986 Dental Request for Prior Approval for Treatment or Referral to a Specialist | For providers, Dental prosthetist, Dental specialist, Dentist, Medical specialist |
| D9287 | D9287 Diagnosis Form | For providers |
| D0653A | D0653A Discharge Advice and Hospital Claim | For providers, Hospitals & day procedure centres |
| D9416 | D9416 Disfigurement and Social Impairment - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9449 | D9449 Disorders of the Colorectum and Anus - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9132 | D9132 Dose Administration Aid (DAA) service VSMR | For providers, Pharmacist |
| D9417 | D9417 Ear Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9471 | D9471 Ear, Nose and Throat Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9482 | D9482 Elbow Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9438 | D9438 Elbow Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9521 | D9521 Employer Incentive Scheme Claim for Reimbursement | For providers |
| D9450 | D9450 Endocrine Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9491 | D9491 Endocrine Disorder(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9400 | D9400 Essential Medical Equipment Payment (EMEP) claim | General, For providers |
| D9384 | D9384 Exceptional Case Interruption to Care | For providers, Registered Nurse |
| D9297 | D9297 Exceptional Case Unit - Request for Reimbursement of Nursing Consumables over $1,000 | For providers |
| D1307 | D1307 Exceptional Case Variation | Registered Nurse, For providers |
| D9470 | D9470 Eye Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9458 | D9458 Eye Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9499 | D9499 Facial Disfigurement - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9488 | D9488 Female Reproductive System - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9428 | D9428 Female Reproductive System - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9489 | D9489 Female Sexual Function - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9427 | D9427 Female Sexual Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9466 | D9466 Fistulae and Hernia Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9478 | D9478 Foot and Toe Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9431 | D9431 Foot and Toe Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9464 | D9464 Gastrointestinal Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9446 | D9446 Gastrointestinal Condition(s) Weight and Nutrition - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9451 | D9451 Haematological Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9436 | D9436 Hand & Fingers Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9484 | D9484 Hand and Finger Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D1221 | D1221 Health practitioner service voucher | General, For providers |
| D9473 | D9473 Hearing Loss and Tinnitus - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9419 | D9419 Hearing Loss and Tinnitus - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9445 | D9445 Hernia and Stoma - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9476 | D9476 Hip Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9434 | D9434 Hip Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9501 | D9501 Historic Condition(s) - (DRCA/MRCA/VEA) | Compensation, For providers |
| D0652B | D0652B Hospital Admission Voucher | For providers, Hospitals & day procedure centres |
| D9455 | D9455 Hypertension - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D6346 | D6346 Intensive Care Patient Certificate | Registered Nurse, For providers, Hospitals & day procedure centres, Medical specialist |
| D9461 | D9461 Intermittent Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9420 | D9420 Intermittent Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9283 | D9283 Job Seeking Questionnaire | For providers, Rehabilitation service provider |
| D9475 | D9475 Knee Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9433 | D9433 Knee Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9465 | D9465 Liver and Biliary Tract Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9448 | D9448 Liver, Pancreas and Gall Bladder Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9498 | D9498 Loss of Efficient Use (LOEU) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9497 | D9497 Lower Urinary Tract - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9477 | D9477 Lower Limb Function (no joint) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9456 | D9456 Lower Limb Oedema and Vascular Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9435 | D9435 Lower Limb(s) Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9486 | D9486 Male Reproductive System - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9426 | D9426 Male Reproductive System - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9487 | D9487 Male Sexual Function - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9425 | D9425 Male Sexual Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9462 | D9462 Malignant Disorder(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9443 | D9443 Malignant Disorder(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9490 | D9490 Mastication and Deglutition - (DRCA) | Compensation (DRCA), Compensation, For providers |
| d9522 | d9522 Medical Certificate - Capacity for Work and/or Rehabilitation | For providers, Medical specialist |
| D0688 | D0688 Medical grade footwear (MGF) prescription form | For providers, Orthotist, Podiatrist/Footwear prescriber |
| D9403 | D9403 Medicinal Cannabis Tier 2 Application | For providers, General Practitioner, Medical specialist, Specialist (includes all medical specialists in relevant field) |
| D9423 | D9423 Mental Health Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9292 | D9292 MRI/PET Scan Prior Financial Approval Request form | For providers, Hospitals & day procedure centres, Medical specialist |
| D9424 | D9424 Neurological Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9468 | D9468 Neurological – Cognition and Communication - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9467 | D9467 Neurological – Cranial Nerves - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D1372 | D1372 Optical dispensing registration form | For providers, Medical specialist, Optometrist, Orthoptist and Optical dispenser |
| D1399 | D1399 Optical treatment prior financial approval request | For providers, Optometrist, Orthoptist and Optical dispenser |
| D1223 | D1223 Optometric, optometry and optical service voucher | General, For providers, Optometrist, Orthoptist and Optical dispenser, Optometrist |
| D9352 | D9352 Orthotist prior financial approval request form | For providers, Orthotist |
| - | - Outreach Program Counsellor (OPC) statutory registration form | For providers, Clinical psychologist, Psychologist, Social worker (mental health) |
| D1218 | D1218 Pathology service voucher | General, For providers |
| D9493 | D9493 Peripheral Vascular Disease - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9421 | D9421 Permanence, Stability and Treatment - (DRCA/MRCA) | Compensation, For providers |
| D9314 | D9314 Prior Approval Request for Treatment of Alcohol and Other Drug Use (AOD) | For providers, Clinical psychologist, Hospitals & day procedure centres, Medical specialist, Neuropsychologist, Psychologist, Social worker (mental health) |
| d9533 | d9533 Prior Financial Authorisation for Ketamine, EsKetamine and TMS for Treatment Resistant Depression | For providers, Psychiatrist |
| D9463 | D9463 Psychiatric Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9459 | D9459 Renal Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9323 | D9323 Request for Prior Approval for Dental Implants | For providers, Dental prosthetist, Dental specialist, Dentist, Hospitals & day procedure centres, Medical specialist |
| D9469 | D9469 Respiratory Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9454 | D9454 Respiratory Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9284 | D9284 Retraining Questionnaire | For providers, Rehabilitation service provider |
| D0570 | D0570 Service Pension Claim - Work Test Questionnaire | For providers |
| D9481 | D9481 Shoulder Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9439 | D9439 Shoulder Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9495 | D9495 Skin Disorder(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9444 | D9444 Skin Disorder(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9460 | D9460 Sleep Disorder(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D0931 | D0931 Spectacles prescription | For providers, Optometrist, Orthoptist and Optical dispenser |
| D9479 | D9479 Thoraco-lumbar Spine Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9442 | D9442 Thoracolumbar Spine Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| TFI01 | TFI01 Tinnitus Functional Index Questionnaire and Scoring Instructions | For providers, Audiologist |
| D1328 | D1328 Treatment prior financial approval request | For providers, Chiropractor, Clinical psychologist, Dental prosthetist, Dental specialist, Dentist, Diabetes educator, Dietitian, Exercise physiologist, General Practitioner, Hospitals & day procedure centres, Medical specialist, Neuropsychologist, Occupational therapist (general), Optometrist, Orthoptist and Optical dispenser, Orthotist, Osteopath, Physiotherapist, Podiatrist/Footwear prescriber, Psychologist, Social worker (mental health), Speech pathologist |
| D1216 | D1216 Treatment service voucher | General, For providers, General Practitioner |
| D1216G | D1216G Treatment service voucher (for use by general practitioners only) | General, For providers, General Practitioner |
| D1216S | D1216S Treatment service voucher (for use by specialists and consultant physicians only) | General, For providers, Physiotherapist, Continence Adviser (Registered nurse or Physiotherapist Continence Adviser), Exercise physiologist |
| D9447 | D9447 Upper Gastrointestinal Tract Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9485 | D9485 Upper Limb Function (no joint) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9440 | D9440 Upper Limb(s) Function - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9422 | D9422 Upper Respiratory Tract - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |
| D9496 | D9496 Upper Urinary Tract - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9494 | D9494 Venous Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9472 | D9472 Vertigo - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9388 | D9388 Veteran Health Check Assessment Tool | For providers |
| D1338 | D1338 Vietnam Veterans' Sons and Daughters Support Program (VVSDSP) - prior approval form | General, For providers, Chiropractor, Clinical psychologist, Dental prosthetist, Dental specialist, Dentist, Dietitian, Exercise physiologist, General Practitioner, Hospitals & day procedure centres, Medical specialist, Neuropsychologist, Occupational therapist (general), Occupational therapist (mental health), Optometrist, Orthoptist and Optical dispenser, Orthotist, Osteopath, Physiotherapist, Podiatrist/Footwear prescriber, Psychologist, Social worker (general), Social worker (mental health), Speech pathologist |
| D9483 | D9483 Wrist Condition(s) - (DRCA) | Compensation (DRCA), Compensation, For providers |
| D9437 | D9437 Wrist Condition(s) - (MRCA/VEA) | Compensation (MRCA/VEA), Compensation, For providers |