Get Au 4703 2015-2025

The AU 4703 form is essential for notifying the Australian Government Department of Human Services about the intention to repay benefits incorrectly paid under Medicare or the Child Dental Benefits Schedules. This guide provides clear, step-by-step instructions on how to complete this form online, ensuring you can submit your information accurately and efficiently.

Follow the steps to successfully complete the AU 4703 form online.

1. Click 'Get Form' button to obtain the AU 4703 form and open it in the web-based editor.
2. Fill in your personal details at the top of the form. This includes your name, contact number, email address, and any alternate address where you wish to be contacted.
3. In the provider details section, indicate your professional title and complete your name, signing as the health professional who rendered the services.
4. Provide your Medicare provider number and the date in the designated fields.
5. Enter the service details by entering the patient’s family name, given name(s), date of birth, and Medicare card number for each relevant service.
6. Document the service dates and item numbers claimed accordingly. If further space is needed, attach a separate sheet and reference it in the comments section.
7. Review all entered information for accuracy and completeness before proceeding.
8. Once all information is verified, save your changes. You can then download or print the form, or share it via email if necessary.

Ensure your compliance by completing the AU 4703 form online today.