Fields marked with an asterisk (*) are required.
If you wish to request a review of a number of conditions, you need to lodge a separate request for each condition attaching or citing the information relevant to that request.
It is recommended that you read the Repatriation Medical Authority's Information sheet for Applicants requesting an Investigation/Review.
I authorise the release of any information to the Authority required to establish my eligibility to make this request. *
[NB. A separate form must be completed for each condition sought to be reviewed]
In the space provided below, please supply any information which you consider is related to your request. Additional pages may be attached if the space below is insufficient. Should you be requesting the Authority to review the contents of a Statement of Principles, please identify which causal factor(s) you wish to have reviewed or considered for inclusion. You should specify any peer-reviewed published information which supports your request.
Attach any documents relevant to your request using the fields below (.doc or .pdf).
Under section 196K of the VEA, certain decisions made by the Authority are reviewable by the Specialist Medical Review Council (SMRC). If a valid application for review by the SMRC is made, the VEA requires the Authority to disclose to the SMRC all information relevant to its determination or decision. This includes applications for investigation or review, and submissions received relevant to the matter being review by the SMRC.
I have read and understood the above disclosure of information statement. *
I have read the RMA Submission Guidelines and understand what is 'sound medical-scientific evidence' (SMSE) which can be used by the RMA to make or amend a SOP. *
I have included information relating to my request which is supportive of the investigation/review requested. *
Once you have submitted your application, the information will be available in a PDF format for you to save (or print out) for your records.
If you would prefer to complete this form on paper, download the form here:
Please print, complete and email this form to firstname.lastname@example.org or mail to:
The RegistrarRepatriation Medical AuthorityGPO Box 1014Brisbane QLD 4001