Application for the Oxygen or Enteral Feeding Supplement form (AC011)

Use this form to advise us that a care recipient within your aged care service is eligible to receive an Oxygen or Enteral Feeding Supplement.

Download and complete the Application for the Oxygen or Enteral Feeding Supplement form.

This form must be completed and signed by an authorised person of the approved provider.

Approved providers must advise us of any changes that vary the amount being claimed, as well as any changes that affect the payment of the benefit to the service.

To submit this form, you can either:

  • register an Oxygen or Enteral Feeding supplement event on the Aged Care Provider Portal and upload all the necessary documentation
  • post it to the address at the top of the form.

To fill in this form digitally you’ll 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 contact us. We can help you access, complete and submit them.

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 contact us. We can help you access, complete and submit them.

Page last updated: 1 October 2022