Fields marked with an asterisk (* ) are required.
It is recommended that you read the RMA Submission Guidelines before making your submission.
Name of person making the submission
Position of person making the submission (if applicable)
Name of organisation on behalf of whom the submission is made (if applicable)
Street
Suburb
State
Postcode
Telephone (business hours)
Telephone (after hours)
Email address
The condition under investigation or review
acute articular cartilage tear
acute meniscal tear of the knee
acute rheumatic fever
Alzheimer-type dementia
anal fissure
blepharitis
chondromalacia patella
chronic insomnia disorder
chronic pruritus ani
coeliac disease
concussion
conductive hearing loss
dental malocclusion
dislocation
Dupuytren's disease
gout
heel bursitis
human immunodeficiency virus
human T-cell lymphotropic virus type-1
hypopituitarism
iliotibial band syndrome
internal derangement of the knee
joint instability
Kaposi's sarcoma
malignant neoplasm of the liver
methaemoglobinaemia
microscopic polyangiitis
migraine
moderate to severe traumatic brain injury
Morton's metatarsalgia
non-Hodgkin's lymphoma
pilonidal sinus
poisoning and toxic reaction from plants and fungi
polyarteritis nodosa
rapidly progressive crescentic glomerulonephritis
renal stone disease
rheumatic heart disease
Ross River virus infection
sarcoidosis
schistosomiasis
sensorineural hearing loss
sinus barotrauma
stenosing tenosynovitis (trigger finger)
strongyloidiasis
subarachnoid haemorrhage
varicocele
xerostomia
In the space provided below, please detail the submission you consider to make for the RMA's
consideration. If you have prepared a submission in a digital form able to be uploaded
(.doc, .docx or .pdf), you have the option of including it as an attachment below.
Attach any documents relevant to your submission using the fields below (.doc, .docx 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.
Once you have completed your submission, the information will be available in a PDF format
for you to save (or print out) for your records.
