Bulk bill voucher - electronically transmitted claims form (DB4E)

Use this form to claim assigned benefits for electronically transmitted claims.

Download and complete the Bulk bill voucher - electronically transmitted claims form.

These services can also be claimed through HPOS Bulk Bill Webclaim capability.

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, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 31 January 2020