Who should fill out this form
You can use this form if you:
• live in Australia, and
• have a current Medicare Card, Department of Veterans’ Affairs (DVA) Gold Card, DVA White Card specific to diabetes, or
• are a resident of a country with which Australia has a Reciprocal Health Care Agreement (and not visiting on a student visa, if a resident of Finland, Malta, Norway or the Republic of Ireland) and
• have been diagnosed with type 1, type 2 or gestational diabetes, or
• have been diagnosed with diabetes caused by a genetic defect, pancreatic disease, hormonal abnormality or exposure to certain drugs and chemicals.
A primary guardian or carer needs to fill out part of this form if the person with diabetes: • is under 15 years old, or
• is 15 or over and receives ongoing care. After those details are complete, the form must be certified by a registered medical practitioner such as your doctor, endocrinologist or obstetrician, a nurse practitioner, or a credentialled diabetes educator.