Download Medical Record of Disability Support Pension for Free

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Instructions for the customer Information for the doctor
This information will help the Australian Government Department of Human Services in determining:
• income support eligibility
• if the customer may benefit from a program of assistance or training
• if the customer is eligible to enter the Supported Wage System.
Completing this report
You can complete and lodge Medical Reports electronically through
Health Professional Online Services (HPOS). For more information
go to our website
and logon to HPOS.
In this report you will be asked to provide information about your
patient’s medical condition(s). Please complete all the required
questions in this report.
If you require another paper copy of the Medical Report, go to our
If you need more information in order to complete the Medical
Report call us on 132 150.
Returning this report to Human Services
You can give this report and any attachments to your patient or you
can return it to
Disability Services
Reply Paid 7806
Medical Report
Disability Support Pension
1 of 11
Customer's details
Full name
Date of birth Customer Reference Number (CRN)
Phone number
Contact your doctor or medical specialist and make an
appointment to have the Medical Report completed.
Make sure the doctor and their receptionist know that you will
need this report completed, as a long consultation may be
required. If your doctor does not bulk bill, your consultation fee
may be more than usual because of the extra time taken to
complete the report.
Important information: A doctor or medical specialist is a person
registered and licensed under a State or Territory law that
provides for the registration or licensing of medical practitioners.
It includes only those with recognised medical qualifications such
as general practitioners and medical specialists and excludes
those with non-medical qualifications (e.g. psychologists or
physiotherapists. Note: If a person has an intellectual impairment
and this is their only condition, the Medical Report can be
completed by the person's treating psychologist).
Attend the appointment with your doctor or medical
Complete your details above.
When your doctor or specialist has completed this Medical
Report, it must be returned to us.
If you have other relevant information such as specialist
medical reports or an assessment of your intellectual
function showing your IQ score (if relevant to your claim),
return them to us with this report.
CLK0SA012 1301
Medical Record of Disability Support Pension
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