Medicare forms
On this page
- Application for prescriber number for a registered medical practitioner
- Bulk Bill Claim Forms
- Pay Group Link
- Medicare Allied Health and Dental Care Initiative
- MRI Statutory Declaration
- Pathology Laboratory Application
- Approved Pathology Practitioner Application
- Remote Area Exemption
- EFT Payments for Claims
- Certification of Cleft Condition form
- Positron Emission Tomography (PET) Statutory Declaration
- Application for Late Lodgment of a claim for Assigned Medicare Benefits
- Electronic referral requests
The application forms in this category cover some aspects of provider, patient and equipment eligibility. Lodgment details are listed on each form.
For enquiries about provider eligibility please call 132 150 (local call rates).
For enquiries about patient eligibility, please call 132 011 (local call rates).
For general PBS and stationery enquiries please call 132 290 (local call rates).
Application for prescriber number for a registered medical practitioner
Bulk Bill Claim Forms
- DB5 – Bulk Bill Assignment continuation form for pathology services only [PDF, 189Kb]
- DB1N – Bulk Bill claim form for Normal Services [PDF, 106Kb]
- DB1H – Bulk Bill claim form for Hospital Services [PDF, 86Kb]
- DB4E – Bulk Bill Assignment Form [PDF, 96Kb]
- DB1N-AH – Bulk Bill claim form for Allied Health Professionals [PDF, 114Kb]
- DB2-AH – Bulk Bill claim form for Allied Health Professionals [PDF, 154Kb]
- DB2-OT – Bulk Bill claim form for Other Practitioners [PDF, 160Kb]
- DB2-OP – Bulk Bill claim form for Optometrists [PDF, 136Kb]
- DB2-GP – Bulk Bill claim form for General Practitioners [PDF, 144Kb]
- DB3 – Bulk Bill claim form for Pathologists [PDF, 136Kb]
- DB4 – Bulk Bill Assignment Form [PDF, 114Kb]
Pay Group Link
A pay group link enables a practitioner to have Medicare benefit cheques, which would have been issued payable to that practitioner at his/her practice address, made payable to another payee associated with the practice and/or another address.
Where the payee is a third party, the payee (or person properly authorised in the case of a body corporate or other entity) must agree to the arrangement by counter-signing the application form.
Medicare Allied Health and Dental Care Initiative
The new Medicare allied health and dental care initiative allows chronically ill people who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for allied health services.
Referral forms
Referral forms are available on the Department of Health and Ageing
website or by faxing a request to (02) 6289 7120.
Eligibility
MRI Statutory Declaration
Pathology Laboratory Application
Approved Pathology Practitioner Application
Remote Area Exemption
EFT Payments for Claims
Certification of Cleft Condition form
Positron Emission Tomography (PET) Statutory Declaration
Application for Late Lodgment of a claim for Assigned Medicare Benefits
Electronic referral requests
If you would like to transmit, scan and/or store Referrals or Requests electronically, please refer to the following Medicare Australia IT standards.
Some documents on this page may require the free Adobe PDF reader.
Last updated: 26 February, 2010