Get Au D9165 2017-2025

The AU D9165 form, also known as the request for nutritional supplementation, is essential for veterans and war widow(er)s to receive subsidised nutritional products. This guide will walk you through the process of completing this form online, ensuring you understand each section and field clearly.

Follow the steps to complete the AU D9165 online.

1. Click ‘Get Form’ button to access the AU D9165 form and open it in your preferred digital editor.
2. Fill in the prescribing doctor section with the name and contact information of the patient’s prescriber. This information is crucial as the doctor will contact VAPAC for the authority prescription.
3. Complete the patient's details by providing their full name, address, current DVA file number (e.g., QX123945), and current DVA card colour (e.g., Gold, White, Orange), ensuring accuracy in this section.
4. Indicate whether the patient is a resident of an aged care facility. If yes, specify the level of care based on ACFI classification.
5. Detail relevant clinical conditions and indications that necessitate nutritional supplementation, such as chronic obstructive airways disease (COAD).
6. Describe any concurrent therapeutic diet management plans that support the request, such as specific dietary requirements.
7. Outline the recommendations for the nutritional supplements, including specific brand, daily usage, quantity required per month, and the number of repeats needed (maximum five).
8. State the mode of feeding, specifying options like oral, PEG, or naso-gastric.
9. Include a follow-up plan indicating when the next review will occur and whether further assessments are necessary.
10. Finally, enter the requesting Dietitian's details, including name, contact number, and Medicare Australia provider number.
11. After completing all sections, ensure to save changes, download or print the form, and share it as necessary.

Start completing your AU D9165 online to ensure prompt access to nutritional supplements.