Discharge Advice and Hospital Claim

Form ID
For providers
Hospitals & day procedure centres

This form is used for Discharge Advice and Hospital Claims. May be referred to as D0653a or D653a.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
Form (PDF or Word)