Provider forms

Authorisation to Release Information Form

Use this form to authorise the release of the patient and member’s details by the patient’s doctors, hospitals and any other authorities to CBHS Corporate Health and CBHS Corporate Health’s medical consultants. The patient (or member if the patient is a dependent on their parent’s membership) must sign the form for the authorisation to take effect.

• Authorisation to Release Information Form

Certificate for Medical Practitioner

Members may need to submit this form if they have joined or upgraded their level of hospital cover in the past 12 months. This medical report allows CBHS Corporate Health’s medical advisors to check whether the member’s condition is a pre-existing condition and determine whether it is covered by the member’s cover.

• Certificate for Medical Practitioner Form

Accident/Injury/Condition Form

The Accident/Injury/Condition Form allows CBHS Corporate Health to access the member’s claim in relation to an accident, injury or condition. You’ll need to outline the nature of the injury or condition and provide other relevant details such as date of occurrence and whether the injury occurred at work. 

• Accident Injury Condition Form

Hospital Special Consideration Forms

• Bone Conduction Hearing Speech Processor Replacement Form
• Cochlear Sound Processor Replacement Upgrade Form
• High Cost Drugs Request Form
• Insulin Pump Replacement Upgrade Form
• Non Prostheses List Payment Request Form
• Vac Therapy Funding Application Form
• Vac Therapy Funding Review Form