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
accommodation disorder
acquired cataract
adjustment disorder
alcohol use disorder
animal envenomation
ascariasis
Barrett's oesophagus
benign neoplasm of the eye and adnexa
benign paroxysmal positional vertigo
blast-induced mild traumatic brain injury
bronchiectasis
bruxism
cardiac myxoma
cholelithiasis
cirrhosis of the liver
complex regional pain syndrome
female sexual dysfunction
femoroacetabular impingement syndrome
fibromuscular dysplasia
haemorrhoids
hepatitis B
hepatitis D
hookworm disease
hypertension
immersion pulmonary oedema
incisional hernia
influenza
labral tear
malaria
malignant neoplasm of the brain
malignant neoplasm of the oesophagus
occipital neuralgia
optochiasmatic arachnoiditis
Parkinson’s disease and secondary parkinsonism
popliteal entrapment syndrome
relapsing polychondritis
rheumatoid arthritis
sarcoidosis
schizophrenia
sensorineural hearing loss
sickle-cell disorder
smallpox
thromboangiitis obliterans
tooth wear
umbilical hernia
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).
Attachment 1
Attachment 2
Attachment 3
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.
