Disaster Health Care Assistance Scheme Motor Vehicle and/or Accommodation Out-of-Pocket Travel Application form (MS042)

Use this form to claim out of pocket costs if you have to travel more than 50kms from your home to see your doctor or medical specialist about your injuries.

Download and complete the Disaster Health Care Assistance Scheme Motor Vehicle and/or Accommodation Out-of-Pocket Travel Application form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 20 March 2024.
QC 65202