Authorisation to act on an incapacitated person's behalf for Medicare purposes form (MO050)

Use this form if you want to act on behalf of someone who is incapable of managing their own affairs for Medicare services.

Download and complete the Authorisation to act on an incapacitated person's behalf for Medicare purposes 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: 14 June 2022