Exceptional Case Unit

Application for Exceptional Case Status

Applications for Exceptional Case Status must be completed on the ‘Application for Exceptional Case Status’ form with Attachments where required.

• Application for Exceptional Case Status (D1004) (PDF 500 KB)

The Exceptional Case Unit (ECU) requires the original signed exceptional case status forms to be able to assess exceptional case status. Photocopies of the exceptional case status forms are not acceptable as they may be difficult to read and interpret.

Relevant attachments should be completed with an application, interruption to care, extension or variation, if required:

• Attachment 1 - Dementia / Short Term Memory Loss / Confusion (D1004A) (PDF 256 KB)
• Attachment 2 - Mental Health (Depression / Anxiety /Posttraumatic Stress Disorder / Alcohol and Substance Misuse) (D1004B)  (PDF 501 KB)
• Attachment 3 - Palliative Care (End of Life / Metastatic Cancer / Non-Malignant Palliative Care) (D1004C) (PDF 358 KB)
• Attachment 4 - Wound Care (D1004D) (PDF 797 KB)

Application for Additional Travel for Exceptional Case Status or Schedule Fees

• Application for Additional Travel for Exceptional Case Status or Schedule Fees  (D1321) (PDF 196 KB)

Notification of Interruption to Care

• Exceptional Case Status - Notification of Interruption to Care (D1019)  (PDF 156 KB)

Variation or Extension

• Exceptional Case Status - Variation or Extension  (D1307) (PDF 166 KB)
• Second worker (D1391)

Palliative Care Forms

Overnight Nursing Care Form

• Palliative Care - Overnight Nursing Form  (D1310) (PDF 172 KB)

Nursing Consumables Form

•  Exceptional Case Unit Request for Funding of Nursing Consumables over $500  (D9297) 

Coordinated Veterans' Care Program Community Nursing Feedback to LMO/GP

• CVC Program Community Nursing LMO/GP Feedback (D1305) (PDF 101 KB)

2nd Provider in 28 day Claim Period

• D9305 Community Nursing Provider Approval Request (PDF 118 KB)