Information about D904 voucher (DVA request/referral)
This voucher should be used when:
- directly referring a veteran to another health care provider
- requesting prior financial authorisation for a treatment service for a veteran
- requesting a rehabilitation appliance for a veteran, or
- requesting an hire car or taxi for a veteran.
LMOs may use their own stationery or letterhead rather than a D904 provided that all the necessary information is included and legible, such as the provider number and date of request/referral.
Using your own stationery
LMOs may use their own stationery or letterhead rather than a D904 provided that all the necessary information is included and legible. This includes but is not restricted to the following information:
- veteran's name
- veteran's DVA file number (shown on the Repatriation Health Card)
- veteran's date of birth
- veteran's address
- veteran's clinical details (including recent illnesses, injuries and current medication, if applicable)
- condition to be treated
- description of the requested service
- LMO's name and provider number and
- date of referral.
For referral to any health care provider, it is the LMO's responsibility to provide the above information about a veteran to ensure that the provider understands the veteran's medical history and to allow the provider to claim payment from DVA.