Continence equipment prescription and order form: Community form (for provider use only)

Summary:

For community continence nurses – use this form to request continence equipment for your patient. You will need to provide a summary of the continence assessment, along with your recommendations.

The form should also be completed when a major review of the continence equipment requirements is conducted (usually every two years) or when there has been a change to the current continence regime.

For help completing this form, see the separate notes document.

Coronavirus update

The TAC is unable to send or receive hard copy documents at this time. We have some different options for you to send us forms, documents or receipts for reimbursement.

Reimbursements

  • myTAC
    Please use our app or web portal, myTAC to ask for reimbursements. Go to upload documents > reimbursement form and send us a photo of your receipt or proof of payment and a description of what you've paid for.
  • Email
    If you can't use myTAC to send your receipts, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.

Forms and documents

  • myTAC
    Please use our app or web portal, myTAC to send forms or documents. Go to upload documents > submit documents and send us a photo of your form or document.
  • Email
    If you can't use myTAC to send your forms or documents, please take a photo and email it to us at info@tac.vic.gov.au. Include your claim number in the subject line of your email so we can process your request.