Midwife Professional Indemnity Scheme forms
Under the Midwife Professional Indemnity Scheme (MPIS) supporting paper documentation must be supplied with each online claim submission. Please include the Midwife Unique Identifier (MUI) number on all documentation.
Send completed forms to Medicare Australia at the following address:
Midwife Professional Indemnity
Department of Human Services
PO Box 1001
TUGGERANONG ACT 2901
MPIS – Application Statutory Declaration
This form must be submitted with each MPIS payment application or adjustment application made to Medicare Australia.
MPIS – ROC Statutory Declarations
A ROC Statutory Declaration must accompany each MPIS ROC claim application made to Medicare Australia.
- MPIS ROC – Statutory Declaration – Midwife with Permanent Disability [PDF, 122Kb]
- MPIS ROC – Statutory Declaration – Midwife 65 and Over [PDF, 122Kb]
- MPIS ROC – Statutory Declaration – Deceased [PDF, 122Kb]
- MPIS ROC – Statutory Declaration – Maternity [PDF, 124Kb]
- MPIS Statutory Declaration – No Private Practice During Proceeding 3 Years [PDF, 123Kb]
MPIS ROC – Medical Certificate for Maternity or Permanent Disability
A ROC Medical Certificate must accompany each MPIS ROC claim where the applicant has applied under a ROC Maternity or Permanent Disability clause.
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Last updated: 15 July, 2011