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.

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

Page last updated: 28 January 2020