Review of a Medicare Decision form (HW051)
Use this form to ask for a review of a decision about your Medicare entitlements or debts including dental benefit, Pharmaceutical Benefit and related payments.
Download and complete the Review of a Medicare Decision form.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
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: 2 March 2021
This information was printed 17 June 2021 from https://www.servicesaustralia.gov.au/individuals/forms/hw051. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.