Use these forms to arrange treatment and support services for veterans and their dependents who have DVA health cards.

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Most often used

Form ID Form name Who can use this form Updated Download
D0992 D0992 - Mobility Functional Support (MFS) products order form For providers, General Practitioner, Hospitals & day procedure centres, Medical specialist, Occupational therapist (general), Physiotherapist, Rehabilitation service provider, Registered Nurse, Exercise physiologist, Podiatrist, Orthotist, Prosthetist 3 April 2025 Download as PDF (120.17 KB)
D0904 D0904 - DVA request/referral voucher For providers, General Practitioner 3 April 2025 Download as PDF (143.53 KB)
D9132 Dose Administration Aid (DAA) service VSMR For providers, Pharmacist 3 April 2025 Download as PDF (305.76 KB)
D9300 D9300 - Electric Mobility Aids - Part 1 - Medical Assessment For providers, General Practitioner 3 April 2025 Download as PDF (168.96 KB)
D0988 D0988 – Continence direct order form For providers, General Practitioner, Medical specialist, Occupational therapist (general), Occupational therapist (mental health), Physiotherapist, Registered Nurse 3 April 2025 Download as PDF (164.89 KB)

All forms

Form ID Form name Who can use this form Updated Download
D9477 Lower Limb Function (no joint) - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (74.55 KB)
D9477 Lower Limb Function (no joint) - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (368.57 KB)
D9456 Lower Limb Oedema and Vascular Condition(s) Compensation, For providers Download as DOCX (69.92 KB)
D9456 Lower Limb Oedema and Vascular Condition(s) Compensation, For providers Download as PDF (193.92 KB)
D9435 Lower Limb(s) Function Compensation, For providers Download as DOCX (72.13 KB)
D9435 Lower Limb(s) Function Compensation, For providers Download as PDF (260.4 KB)
D9426 Male Reproductive System Compensation, For providers Download as DOCX (60.03 KB)
D9426 Male Reproductive System Compensation, For providers Download as PDF (257.64 KB)
D9486 Male Reproductive System - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (75.01 KB)
D9486 Male Reproductive System - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (345.93 KB)
D9425 Male Sexual Function Compensation, For providers Download as DOCX (1.54 MB)
D9425 Male Sexual Function Compensation, For providers Download as PDF (232.26 KB)
D9487 Male Sexual Function - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (67.24 KB)
D9487 Male Sexual Function - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (229.97 KB)
D9443 Malignant Disorder(s) Compensation, For providers Download as DOCX (71 KB)
D9443 Malignant Disorder(s) Compensation, For providers Download as PDF (309.73 KB)
D9462 Malignant Disorder(s) - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (77.17 KB)
D9462 Malignant Disorder(s) - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (493.85 KB)
D9490 Mastication and Deglutition - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (69.68 KB)
D9490 Mastication and Deglutition - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (279.77 KB)
d9522 Medical Certificate - Capacity for Work and/or Rehabilitation For providers, Medical specialist Download as DOCX (57.34 KB)
D0688 Medical grade footwear (MGF) prescription form For providers, Orthotist, Podiatrist/Footwear prescriber Download as PDF (229.45 KB)
D9292 Medical Imaging Prior Financial Authorisation form For providers, Hospitals & day procedure centres, Imaging and radiology providers Download as PDF (157.24 KB)
D9423 Mental Health Condition(s) Compensation, For providers Download as DOCX (1.56 MB)
D9423 Mental Health Condition(s) Compensation, For providers Download as PDF (323.39 KB)