Medical Disclosure Authority (multiple practitioners)

Form ID
D9291
Audience
For providers
General Practitioner
Hospitals & day procedure centres
Medical specialist
Rehabilitation service provider

This form allows clients to authorise multiple medical practitioners, to disclose their medical information to their Rehabilitation Provider and/or their DVA Rehabilitation Coordinator.

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?
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Form (PDF or Word)