Above Rate Service Agreement

Find out how to apply and get more information  about TAC Above Rate Service Agreement. Read and fill up the form regarding your service agreement.

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Allied Health Treatment and Recovery Plan

Check out the Allied Health Treatment and Recovery Plan to aid in your rehabilitation journey. Contact TAC to learn more about the plan and its benefits.

Allied Health Treatment and Recovery Plan

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Assistive technology assessment and recommendations

TAC offers assistive technology assessments for injury-related needs with required solutions and resources to aid recovery. Contact us for further details.

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Assistive technology assessment and recommendations form

Complete the assistive technology assessment and recommendations to review a client’s assistive technology needs and provide recommendations. Submit for consideration of approval and provision of the recommended assistive technology is approved for provision.

For basic equipment, use the basic equipment request form.

Contact the TAC for more information.

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Attendant care calculator

A tool to help calculate recommended attendant care hours, including week to week variations and when 2:1 care is needed.  It is particularly useful when completing a review of capability or partial review of capability assessment.

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Attendant Care Overnight Task Log

Learn about TAC's Attendant Care Overnight Task Log and how it helps manage care services. Contact TAC for details on filling out the log and its usage.

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Audiology - Hearing assessment and device request form

Get the Audiology Hearing Assessment and Device Request Form for clients. Submit to access hearing aids and assessments and reach out for queries.

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Authority to release information form - client representatives

For client representatives – complete this form to provide us with permission to obtain information and documents from your client’s medical practitioners, employer, government agencies and other relevant parties regarding their claim, their health and their employment details.

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Basic equipment request form

This form can be used by a registered medical practitioner or a therapist with relevant expertise to request the purchase or hire of basic equipment for a TAC client.

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Care Online access request

For attendant care providers – Use this form to request access to the Care Online electronic payment system.

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Certificate of Capacity form

The Certificate of Capacity Form allows medical professionals to assess clients' work capabilities. Access the form and submit for claim support.

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Common Law Time limit protocols

Review the Common Law Time Limit Protocols to ensure timely claims. Understand the procedures and file within the limits. Contact TAC for clarification.

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Community access and transport assessment recommendations

Complete the community access and transport assessment to assess a client’s community access and transport needs and provide recommendations for supports and interventions. Submit for TAC’s consideration. Contact the TAC for more information.

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Community Access Plan: Initial plan and request for funding form (for Provider use only)

Providers can submit the initial Community Access Plan and request funding. Complete the form or reach out to TAC for further assistance about the plan.

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Community Access Plan: Progress and/or outcome report form (for Provider use only)

Report on the progress of Community Access Plans with this form. Keep TAC informed and stay on track. Get in touch for more support.

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Community discharge assessment form

Complete the Community Discharge Assessment form for post-hospital support services. Submit for review and assistance. Contact TAC for guidance.

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

Use this form to request continence equipment for community use. Submit to receive necessary items. Contact TAC for further assistance.

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Continence equipment prescription and order form: Hospital discharge

Complete this form to receive continence equipment upon hospital discharge. Get the form and submit your request today. Reach out to TAC for more help.

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Dental: dental report form

Access the Dental Report form for assessment and treatment recommendations. Complete and submit for your dental claims. Contact TAC for assistance.

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Dental: maxillo facial report form

The Maxillo Facial Dental Report form helps with treatment recommendations. Submit for coverage of necessary services. Contact TAC for more info.

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Education support: individual education plan

Submit the Individual Education Plan for educational support services. Get the necessary form and apply for assistance. Contact TAC to get started.

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Education support services: Application for aide, teacher or tutoring request form

Complete the Education Support Services application for aide, teacher, or tutoring requests. Access resources for educational assistance. Contact us.

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Epworth Hospital Transitional Living Centre - Request for admission extension form

Request an extension for admission at the Epworth Hospital Transitional Living Centre. Submit for continued rehabilitation services and contact for details.

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Epworth Hospital Transitional Living Centre - Request for admission form

Submit the request for admission to the Epworth Hospital Transitional Living Centre for rehabilitative care. Get the form and submit today.

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Equipment prescription form

Fill the Equipment Prescription Form to request necessary medical equipment. Complete the form and access essential items. Get in touch for support.

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Exit Report (for Assertive Outreach or Case Management)

Provide an exit report for outreach or case management services. Ensure smooth transitions with detailed documentation. Contact TAC for assistance.

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Funeral and Dependency Benefits claim form

Submit the Funeral and dependency benefits claim form to access funeral and dependency support. Start your claim with the TAC today.

Funeral and dependency benefits claim form

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Group Formats

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Gym and Pool Membership Request and Evaluation Form (for Provider use only)

The Gym and pool membership request and evaluation form is for provider use only.

Gym and pool membership request and evaluation form

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Holiday support plan

Complete the holiday support plan to assess the client’s support needs for vacation or travel. Submit for TAC’s consideration. Contact the TAC for more information.

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Home modifications assessment and recommendations

Complete the Home Modifications Assessment for tailored recommendations on home adaptations. Submit to start the process.

Prior to commencing a complex home modifications assessment and recommendations and report, seek approval from a Home Modification Specialist who will provide you with the report template.

Contact TAC for details.

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Home services assessment and plan

Complete the home services assessment and plan to assess the client’s need for initial support at home. Submit for TAC’s consideration. Contact the TAC for more information.

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Home services review

Complete the home services review to review a client’s current home support and recommend any changes or further support required. Submit for TAC’s consideration. Contact the TAC for more information.

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Hospital direct equipment order form

Order hospital equipment directly with the Hospital Direct Equipment Order form. Submit to receive the necessary items. Contact TAC for more information.

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Initial needs assessment for (Assertive Outreach or Case Management)

For Assertive Outreach or Case Management – complete this form to provide an initial assessment of a client's support needs and goals for an assertive outreach or case management referral.

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Initial occupational therapy assessment

Complete and submit the initial occupational therapy assessment to determine rehabilitation needs and request an initial period of occupational therapy services. Submit for approval of further support. Contact the TAC for more information.

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Integration support: aide account form

Submit the Aide Account Form to access integration support services. Fill the form to receive the necessary assistance. Contact TAC for further queries.

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Integration support: goal development worksheet

Use the Goal Development Worksheet to set objectives for integration support services. Submit for tailored assistance. Contact TAC for more information.

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Integration support: teacher account form

Fill out the Teacher Account Form to access integration support for educational professionals. Get started today or reach out to TAC for further assistance.

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Legal forms

TAC Protocols forms for legal providers. Includes JME request, JME reschedule, Impairment application, Serious Injury application, Dispute application and JME supplementary report request forms.

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Living in the community assessment form

Complete the Living in the Community Assessment to evaluate rehabilitation and support needs. Submit for personalized care. Contact TAC for help.

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Manual handling assessment

Complete the manual handling assessment to assess manual handling risks and recommended strategies or supports to reduce risk and improve safety. Submit for TAC’s consideration. Contact the TAC for more information.

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Medical and pharmacy questionnaire

Submit the Medical and Pharmacy Questionnaire for accurate treatment and pharmacy assessments. Contact TAC for more details regarding the plan.

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Medicinal Cannabis for Chronic Non Cancer Pain (CNCP) request form

Submit the request form for Medicinal Cannabis to treat chronic non-cancer pain. Get started and submit for approval. Contact TAC for assistance.

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Mental health (social work, psychology and neuropsychology): treatment plan

Please choose the Mental Health treatment plan for your discipline. Submit for care options. Please reach out to the TAC for further support.

Mental Health Treatment Plan (Psychology and social work)

Mental Health Treatment Plan (Neuropsychology)

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Network Pain Management Program: Comprehensive Report and Ongoing Management Plan

Submit the Comprehensive Report and Management Plan for the Network Pain Management Program. Get your report today. Contact TAC for support.

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Network Pain Management Program: Follow Up Report and Plan

Provide a follow-up report for the Network Pain Management Program. Complete the form and ensure ongoing care. Contact TAC for support and queries.

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Network Pain Management Program: Non-Completion of Program Report

Submit the Non-Completion of Program Report for the Network Pain Management Program and ensure accurate documentation. Contact us for details.

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Occupational Therapy access registry form

This form is for occupational therapists who wish to join the TAC OT Access Registry.

You can also use the form to update your Access Registry details or ask us to remove you from the Access Registry.

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Occupational Therapy paediatric assessment report

Complete the Occupational Therapy Paediatric Assessment to determine rehabilitation needs and request an initial period of occupational therapy intervention for clients under the age of 16. Submit for TAC’s consideration.  Contact the TAC for more information.

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Occupational therapy review of capabilities

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Occupational therapy service plan review

Complete the occupational therapy service plan to review and recommend occupational therapy intervention. Submit for approval of further support. Contact the TAC for more information.

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Occupational therapy supported accommodation review of capabilities

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Opioid Safety and Management

Review and complete the Opioid Safety and Management plan for effective pain control. Submit the form for ongoing support. Contact TAC for guidance.

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Orthotics device request form

Complete the Orthotics Device Request form for tailored support and device access. Submit for processing today. Connect with TAC for further assistance.

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Outpatient Rehabilitation plan form

Submit the Outpatient Rehabilitation Plan form to access rehabilitation services. Get the plan in place for ongoing recovery. Contact TAC for more details.

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Pain management service: inpatient multidisciplinary assessment form

Complete the Inpatient Multidisciplinary Assessment form for pain management services. Submit for review and approval. Reach out to TAC for assistance.

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Pain management service: outpatient multidisciplinary assessment form

Submit the Outpatient Multidisciplinary Assessment form for pain management services. Get your treatment plan in place. Contact TAC for support.

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Pharmacy: erectile dysfunction questionnaire

Complete the Erectile Dysfunction Questionnaire for accurate treatment recommendations. Submit today for assistance. Contact TAC for more details.

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Position Formats

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Progress Report (for Assertive Outreach or Case Management)

Use the Progress Report form for outreach and case management services. Submit to keep your case up to date. Get in touch with TAC for guidance.

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Prosthetics: management review lower extremity form

Submit the Prosthetics Management Review form for lower extremities. Access tailored prosthetic solutions. Get in touch with TAC for further support.

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Prosthetics: management review upper extremity form

Complete the Prosthetics Management Review for upper extremities. Submit for tailored care and solutions. Contact TAC for assistance.

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Prosthetics: treatment request form

Submit the Prosthetics Treatment Request form for comprehensive care solutions. Get started and receive the necessary support. Contact us for clarity.

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Provider Online Services registration application form

This form can be used by health services to request access the Provider Online Services (POS). This is a secure internet portal owned and operated by the Transport Accident Commission (TAC) and WorkSafe Victoria. POS enables you to check a patient's TAC / WorkSafe Victoria claim status. Please send your completed form to hdsg_admin@tac.vic.gov.au.

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Provider registration

Our health and service providers give vital treatment and support to our clients after a transport accident.

Please complete our online registration form to:

• Provide services to our clients
• Receive email communication and updates from us relevant to your profession

If you would prefer to complete your provider registration by hand, please send it via either:

• Email: info@tac.vic.gov.au, or
• Post: Data Maintenance, Transport Accident Commission,
  GPO Box 2751 Melbourne, Victoria, 3001

Health and service provider registration form - online

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Rehabilitation at home discharge form

Check out the Rehabilitation at Home Discharge form for post-care services. Submit for ongoing home-based recovery. Contact TAC for support.

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Rehabilitation at home extension request

Request an extension for rehabilitation at home services. Complete the extension request form for continued care. Contact TAC for assistance.

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Rehabilitation at home initial assessment

Submit the Rehabilitation at Home Initial Assessment to start home-based rehabilitation. Get started with your assessment. Contact TAC for support.

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Release of information solicitors forms

Complete the Release of Information Solicitors form for client data access and submit to begin the processing. Contact TAC for more details.

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Repetitive transcranial magnetic stimulation request

Submit the request for Repetitive Transcranial Magnetic Stimulation for therapeutic treatment. Get started with your request. Contact TAC for support.

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Restrictive Practice Providers

This is the list of the 39 Disability Service Providers  who are in scope for Phase 1 of the Restrictive Practices Policy (to be implemented in April 2025)

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Return to work: plan form

Create your Return to Work Plan with this form and ensure successful re-entry into the workplace. Contact TAC for assistance.

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Ride-on mower assessment and recommendations

Occupational therapists – complete this form for all requests for ride-on-mowers and like vehicles (e.g. side-by-side and farm utility vehicles) and related equipment (e.g. tow-behind weed sprayers and trailers) for a TAC client.

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Sedative Management Plan (SMP) form

Submit the TAC Sedative Management Plan form. Access the TAC Shared Supported Accommodation Property Enrolment Application for enhanced care options.

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Serious incident and restrictive practice

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Shared Supported Accommodation Property Enrolment Application

Complete the TAC Shared Supported Accommodation Property Enrolment Application. Learn about TAC Protocols Tabs for seamless provider support.

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Shared Supported Accommodation Provider Registration

Register for TAC Shared Supported Accommodation Provider and explore TAC Telehealth Resources for enhanced care and support options.

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Sleep Disordered Breathing & CPAP Questionnaire

Complete the TAC Sleep Disordered Breathing & CPAP Questionnaire. Ensure your clients receive the right support for their sleep health needs.

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Special education: Assessment and recommendations form

Submit the TAC Special Education Assessment and Recommendations form. Learn how TAC can support your client’s ongoing educational needs.

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Special education: Review and request ongoing services form

Submit the TAC Special Education Review form and request ongoing services. Learn about TAC's Speech Pathology Policy for better client support.

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Speech pathology: management review plan (SPMR) form

Submit the TAC Speech Pathology Management Review Plan (SPMR) form. Discover how TAC's Support at Home can assist with your clients' ongoing care needs.

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Speech pathology: treatment notification plan (SPTNP) form

Submit the TAC Speech Pathology Treatment Notification Plan (SPTNP) form. Learn about TAC's Support at Home Policy for tailored recovery assistance.

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Surgery request form

Submit the TAC Surgery Request Form for approvals. Learn about TAC's Questionnaire Fees to ensure accurate billing and support throughout the process.

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TAC freedom of information (FOI) application form - represented client

Complete the TAC Freedom of Information (FOI) Application Form for represented clients. Learn about TAC’s support for unlicensed drivers and services available.

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Transition allied health and support plan

Access the TAC Transition Allied Health and Support Plan form. Learn about TAC’s travel and accommodation support to assist with your clients' recovery.

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Travel expenses: declaration for carers (for Provider use only)

Submit the TAC Travel Form for provider use and update your provider contact details easily. Keep your information current for seamless support.

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Tutoring support form

Complete the TAC Tutoring Support Form for education help. Access the TAC Urgent Psychiatric Admission Request for Funding Form for urgent care needs.

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Type Formats

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Update provider bank details

Revise your TAC provider bank details quickly. Complete this form to update your bank account details with us so your payments can be transferred to your new account.

Complete online – Update provider bank details

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Update provider contact details

Update your TAC provider contact details quickly.

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Urgent psychiatric admission: Request for funding form

Fill out the Urgent Psychiatric Admission Request form for immediate care. Ensure funding for psychiatric services. Reach out to TAC for assistance.

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Vehicle modifications assessment and recommendations

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Vocational Rehabilitation Suspension Report

Access the TAC Vocational Rehabilitation Suspension Report and understand the process. Use this form when vocational assistance to our clients needs to be suspended.