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
adrenal insufficiency
Alzheimer disease
benign paroxysmal positional vertigo
bipolar disorder
blepharitis
bronchiectasis
bronchiolitis obliterans organising pneumonia
central serous chorioretinopathy
cerebral meningioma
chilblains
chondromalacia patella
chronic insomnia disorder
chronic multisymptom illness
chronic pruritus ani
cirrhosis of the liver
cluster headache
concussion
Cushing syndrome
de Quervain tendinopathy
dental malocclusion
Dupuytren disease
electrical injury
Guillain-Barre syndrome
hepatitis C
herpes simplex
human immunodeficiency virus infection
human T-cell lymphotropic virus type-1 infection
hypopituitarism
iliotibial band syndrome
immersion pulmonary oedema
immune thrombocytopaenia
influenza
internal derangement of the knee
knee bursitis
localised sclerosis
macular degeneration
malignant neoplasm of the cerebral meninges
malignant neoplasm of the eye
malignant neoplasm of the ovary
mesenteric panniculitis
methaemoglobinaemia
migraine
moderate to severe traumatic brain injury
neurocognitive disorder with Lewy bodies
non-freezing cold injury
non-Hodgkin lymphoma
olecranon bursitis
osteoarthritis
panic disorder
personality disorder
pilonidal sinus
popliteal cyst
reactive arthritis
rheumatoid arthritis
scrub typhus
sinus barotrauma
sinusitis
substance use disorder
systemic sclerosis
temporomandibular disorder
tension-type headache
toxic retinopathy
trigger finger
ulnar neuropathy at the elbow
Zika virus infection
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.
