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
accidental hypothermia
accommodation disorder
acquired cataract
adrenal insufficiency
animal envenomation
benign paroxysmal positional vertigo
bipolar disorder
bronchiectasis
bronchiolitis obliterans organising pneumonia
bruxism
central serous chorioretinopathy
cerebral meningioma
chilblains
chronic multisymptom illness
cirrhosis of the liver
cluster headache
complex regional pain syndrome
Cushing syndrome
electrical injury
female sexual dysfunction
femoroacetabular impingement syndrome
frostbite
Guillain-Barre syndrome
haemorrhoids
hepatitis B
hepatitis C
herpes simplex
immersion pulmonary oedema
immune thrombocytopaenia
influenza
knee bursitis
labral tear
localised sclerosis
macular degeneration
malaria
malignant neoplasm of the brain
malignant neoplasm of the cerebral meninges
malignant neoplasm of the eye
malignant neoplasm of the oesophagus
malignant neoplasm of the ovary
mesenteric panniculitis
migraine
non-freezing cold injury
olecranon bursitis
osteoarthritis
panic disorder
personality disorder
popliteal cyst
popliteal entrapment syndrome
reactive arthritis
relapsing polychondritis
rheumatoid arthritis
schizophrenia
scrub typhus
sickle-cell disorder
signal to noise ratio hearing loss
sinusitis
smallpox
substance use disorder
systemic sclerosis
temporomandibular disorder
tension-type headache
thromboangiitis obliterans
tooth wear
toxic retinopathy
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.
