Get Au D9165 2014

The AU D9165 is a request form for nutritional supplementation for eligible veterans and war widow(er)s. This guide will provide clear, step-by-step instructions to help users fill out the form accurately and efficiently.

Follow the steps to fill out the AU D9165 with ease

1. Press the ‘Get Form’ button to access the AU D9165 document and open it in your preferred editor.
2. Begin with the section for the prescribing doctor. Provide the full name and contact details, including their phone and fax numbers. Ensure accuracy as this information is crucial for communication with VAPAC.
3. Next, fill in the patient’s details. Include the full name, address, DVA file number, and choose the current DVA card color (Gold, White, or Orange), ensuring you select the correct eligibility status.
4. If the patient resides in an aged care facility, indicate their care level. Select 'No' or 'Yes' and specify whether they have lower care needs or greater care needs.
5. In the relevant clinical conditions section, list any clinical states justifying the need for nutritional supplementation, such as COPD or weight loss from cancer.
6. Provide details regarding any concurrent dietary management plans that may support the request for nutritional products.
7. List the recommendations for the nutritional supplement, including the specific item, daily usage, quantity required per month, and the number of repeats (up to a maximum of 5).
8. Indicate the mode of feeding required. Options include oral, PEG, jejunostomy, or naso-gastric.
9. Complete the follow-up plan section by stating the monitoring schedule, including the date of the next review or indicating if no further reviews are necessary.
10. Lastly, provide the details for the requesting dietitian, including their name, contact number, email, and DVA provider number. Ensure this is complete before submission.
11. After completing the form, make sure to save your changes. You can then download, print, or share the form as required.

Complete your AU D9165 online today to ensure timely access to necessary nutritional supplements.