Claim for Essential Medical Equipment Payment form (SA440)

Use this form if you are claiming for the Essential Medical Equipment Payment (EMEP).

Download and complete the Essential Medical Equipment Payment Claim form.

Your doctor will need to fill in the Medical practitioners confirmation section in the form before you submit it.

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: 30 September 2023.
QC 54901