Request services for participants

Our participants have severe injuries which often require treatment, rehabilitation and care from multiple service providers.

These services are usually organised and requested as part of a plan by the participant's case manager.

This case manager should be the primary point of contact for other service providers.

Case managers work with the participant to identify their short and long term goals, and will then work with other service providers to determine the services required to meet those goals.

Specific forms must be filled out before we can approve those services. Depending on the type of service (or equipment) being requested, either you or the case manager may be able to complete these forms, but talk to the case manager or LTCS Coordinator first.

If you're an individual service provider, such as a physiotherapist or occupational therapist, you should liaise with the case manager to inform them of the participant's needs, and the types and amounts of services they require to meet their ongoing goals. These services can be requested as part of the participant's plan.

If a participant doesn't have a case manager, you can liaise with the participant's LTCS coordinator to request these services.

For additional details on the roles of case managers and LTCS coordinators, see our information sheet.

All providers should also be familiar with the Lifetime Care and Support Guidelines and refer to the 'reasonable and necessary' criteria when requesting services.


All requests for services and equipment for a participant need to be submitted to us on the correct form. Requests should include the payment codes for the treatment, rehabilitation or care service being requested.

Read our summary of forms to request services document to help you know which form you should fill out.

If you're unsure about which form or payment code to use, you can contact the participant's LTCS coordinator on 1300 738 586.

All requests for services should be submitted electronically to or by fax: 1300 738 583.

Type of issue

Form and description/other guidance


Neuropsychology Assessment Notification Form

Use this form for Scheme participants who also have a compulsory third party (CTP)claim, prior to undertaking a neuropsychology assessment. This form should be completed and distributed by whoever is arranging the assessment.


Discharge Service Notification form – Adults

Discharge Service Notification form – Children

Use one of these forms to notify us of the services the participant requires on discharge from hospital.


My Plan

My Plan is our person-centred planning approach and toolkit that was launched in September 2015 to assist participants to plan for the things they want to do and achieve once they are living in the community. See planning with participants for more information and forms.

Assessment and Service requests

Assessment Request form

Use this form to request assessments required either before a Community Living Plan can be developed, or that were unforeseen when the Community Living Plan was submitted. This should be used for the assessment and report (if required) only, not for any additional services.

Service Request form

Use this form to request services outside of those approved in the Community Living Plan. Contact the participant's LTCS Coordinator prior to submitting this form.

Care needs

Care Needs Report (adults)

Use this form to document the participant's overall care needs related to the motor accident injury.

Care and Needs Scale (for adults)

The Care and Needs Scale (CANS) must be completed when undertaking a care needs review for adult participants with a brain injury.

Care needs report (PCANS-2) (for children ages 5-15 years)

Service providers should use this form to document the overall care needs for children and young people (aged 5-15 years) related to the motor accident injury and submit with the most recent PCANS-2. See Participant assessment tools for more information and forms for the PCANS-2.

Attendant Care Service Request

Use this form to request the attendant care services the participant would like to receive. This request needs to be linked to a Care Needs Report (adults and children under 5 years) or Care Needs Report - PCANS -2 (children and young people aged 5 - 15 years).


Equipment Request form

Use this form to request equipment, aids or appliances (excluding continence or consumable products) for all participants. Equipment prescribers are required to meet the qualifications and experience listed in the Professional Criteria for Prescribers.

All equipment requests (except EasyOrder) should be sent to


EasyOrder can be used by Lifetime Care coordinators, occupational therapists, physiotherapists, speech pathologists, clinical nurse consultants and case managers to order low cost/low risk equipment (up to $800) without first completing an Equipment Request Form. Lifetime Care Coordinators are able to order these items on behalf of clinicians who do not have access to the EasyOrder Scheme. For more information about the EasyOrder scheme, speak with a coordinator or email

All EasyOrder requests should be sent to

Equipment Evaluation Form

Use this form to evaluate participant's equipment.  Should be completed following a minimum of four weeks of use in the participant's home or community.

MOTOmed participant agreement

We have purchased a MOTOmed for participants on a 'loan' basis. Participants wishing to access this item must have a current treating physiotherapist to assist with the set up, program design and outcome measurement of the loan.

For more information, speak with a coordinator, or email the equipment officer at

Continence and Consumables Request Form

Use this form to prescribe and request continence equipment and ongoing consumables for a participant. Consumables are items required regularly and normally disposed of after single or several uses (e.g. catheters, catheter bags, dressings, feeding tubes).

Prosthetic request form

Use this form when a new, interim or permanent prosthesis is required, or to change a prescription of an existing prosthesis (excluding socket replacements).

Prosthetic repair/replacement and consumables request form

Use this form when repair or replacement of a prosthetic component is required, or to request prosthetic consumables (e.g. liners or stump socks).

Home modifications

Discharge destination form

Use this form to advise us of a participant's current status and proposed discharge destination. This form can be completed by the participant, a family member or guardian or therapist. The information in this form helps us to determine whether a minor or major home modification may be required. Major home modification assessments can only be completed by our panel of building modification occupational therapists

Minor building modification assessment report & authority to install form

Use this form for assessing and reporting on the participant's status and their minor home modification needs. It also includes an Authority to Install which must be signed by the owner of the property (whether the owner is the participant or someone else) to agree to the proposed modifications.

Major building modification assessment report

Building modification occupational therapists from our panel can use this form for assessing and reporting on the participant's status and their major home modification needs.

Building modification variation request

Building modification occupational therapists and project managers from our panel can use this form to request additional costs outside the approved project plan or fee schedule for major home modifications. This form needs to be submitted and written approval received fromusprior to providing the requested variation in services.

Education and vocational services

Education Support Request

Use this form to request education support services for school aged participants.The school can submit a request for additional education services by completing this form.

All requests for tutoring should be included in an Education Support Request – refer to our Guidance Note – Requests for tutoring for students with a brain injury

Work Options Plan

Use this form to clarify pre-vocational and work options and identify the recommended services for Participants.

Participant Training Request Form

Use this form to request pre-vocational and vocational training for participants. This should be linked to the Work Options Plan.


Participant Travel Booking Form

Use this form to request travel and accommodation bookings for a participant, including taxi E-Tickets and vouchers.

Provider Travel Booking Form

Use this form to request travel and accommodation bookings for a service provider.

Cabcharge Booking Form

Use this form to request taxi E-Tickets/vouchers only for participants or service providers.