Requesting a service

Our workers have severe injuries which often require treatment, rehabilitation and care from multiple service providers. These services are usually organised and requested as part of a plan by the worker's rehabilitation case manager.

This rehabilitation case manager should be the primary point of contact for other service providers. Rehabilitation case managers plan with the worker to identify their goals and support needs, and will then work with other service providers to identify the services needed to meet those goals.

Specific forms must be completed before we can approve services. Depending on the type of service (or equipment) being requested, either you or the rehabilitation case manager may be able to complete these forms, but consult with the case manager or workers care coordinator first. If you're an individual service provider, such as a physiotherapist or occupational therapist, you should liaise with the case manager to inform them of the worker's needs, and the types and amounts of services they require to meet their ongoing goals. These services can be requested as part of the worker's plan.

If a worker does not have a rehabilitation case manager, you can liaise with the worker's coordinator to request these services.


All requests for services and equipment for a worker need to be submitted to us on the correct form. Requests should include the payment codes for the treatment, rehabilitation or care service being requested. Download the payment codes.

If you're unsure about which form or payment code to use, you can contact the worker's coordinator on 1300 738 586.

All requests for services should be submitted electronically to or by fax: 1300 738 583.

Type of Request Form and description/other guidance

Download the Discharge Service Notification form
Use this form to notify us of the services the worker requires on discharge from hospital.


My Plan
My Plan is our person-centred planning approach and toolkit to assist workers to plan for the things they want to do and achieve once they are living in the community. See planning with workers for more information and forms.

Assessment and Service requests

Download the Assessment Request form
Use this form to request assessments required either before a My Plan can be developed, or that were unforeseen when the My Plan was completed. This should be used for the assessment and report (if required) only, not for any additional services.

Download the Service Request form
Use this form to request services outside of those approved in the My Plan.

Care Needs

Download the Care Needs Report
Use this form to document the worker's care needs related to their injury.

Download the Care and Needs Scale
The Care and Needs Scale (CANS) must be completed when undertaking a care needs review for workers with a brain injury.

Download the FIM™ score sheet for brain injury
Download the FIM™ score sheet for burns
Use these forms to monitor a worker’s functional change.

Download the Attendant Care Service Request
Use this form to request the attendant care services the worker would like to receive. This request needs to be linked to a Care Needs Report.

Equipment, continence and consumables, and prosthetics

Download the Equipment Request form
Use this form to request equipment, aids or appliances (excluding continence or consumable products) for all workers. Equipment prescribers are required to meet the qualifications and experience listed in icare lifetime care’s Professional Criteria for Prescribers.
All equipment requests (except EasyOrder) should be sent to

EasyOrder can be used by workers care coordinators, occupational therapists, physiotherapists, speech pathologists, clinical nurse consultants and case managers to order low cost/low risk equipment (up to $800) without first completing an Equipment Request Form. workers care coordinators are able to order these items on behalf of clinicians who do not have access to the EasyOrder Scheme. For more information speak with the coordinator.

Download the Equipment Evaluation Form
Use this form to evaluate a worker's equipment.  This should be completed following a minimum of four weeks of use in the worker's home or community.

Download the Continence and Consumables Request Form
Use this form to prescribe and request continence equipment and ongoing consumables for a worker. Consumables are items required regularly and normally disposed of after single or several uses (e.g. catheters, catheter bags, dressings, feeding tubes).

Download the Prosthetic request form
Use this form when a new, interim or permanent prosthesis is required, or to change a prescription of an existing prosthesis (excluding socket replacements).

Download the Prosthetic repair/replacement and consumables request form
Use this form when repair or replacement of a prosthetic component is required, or to request prosthetic consumables (e.g. liners or stump socks).

Home modifications

Download the Discharge destination form
Use this form to advise us of a worker's current status and proposed discharge destination. This form can be completed by the worker, a family member or therapist. The information in this form helps us to determine whether a minor or major home modification may be required. Major home modification assessments can only be completed by our panel of building modification occupational therapists.

Download the minor building modification assessment report & authority to install form
Use this form for assessing and reporting on the worker's status and their minor home modification needs. It also includes an Authority to Install which must be signed by the owner of the property (whether the owner is the worker or someone else) to agree to the proposed modifications.

Download the major building modification assessment report
Building modification occupational therapists from our panel can use this form for assessing and reporting on the worker's status and their major home modification needs.

Download the building modification variation request
Building modification occupational therapists and project managers from our panel can use this form to request additional costs outside the approved project plan or fee schedule for major home modifications. This form needs to be submitted and written approval received from us prior to providing the requested variation in services.


Download the Worker Travel Booking Form
Use this form to request travel and accommodation bookings for a worker, including taxi E-Tickets.

Download the Provider Travel Booking Form
Use this form to request travel and accommodation bookings for a service provider, including taxi E-Tickets.

Download the Cab charge booking form
Use this form to request taxi E-Tickets only

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information for service providers

Contact Us

1300 738 586
9am to 5pm
Mon to Fri