Provider forms

On some occasions, CBHS may need to obtain information directly from providers such as hospitals, doctors and other health professionals. These are the forms used for HELPER registration, hospital payments, information release authorisation, medical practitioner certificates and accident/injury/condition forms.

Provider Forms

HELPER Registration Form

CBHS HELPER Registration Form is used to authorise hospitals and people to access CBHS’s Hospital Extranet Link for Patient Eligibility Records. The HELPER system gives named individuals access to private patient eligibility individual over the internet.

Authorisation to Release Information Form

Use this form to authorise the release of the patient and member’s details by the patient’s doctors, hospitals and any other authorities to CBHS and CBHS’s medical consultants. The patient (or member if the patient is a dependent on their parent’s membership) must sign the form for the authorisation to take effect.

Certificate for Medical Practitioner

Members may need to submit this form if they have joined or upgraded their level of hospital cover in the past 12 months. This medical report allows CBHS’s medical advisors to check whether the member’s condition is a pre-existing condition and determine whether it is covered by the member’s cover.

Accident/Injury/Condition Form

The Accident/Injury/Condition Form allows CBHS to access the member’s claim in relation to an accident, injury or condition. You’ll need to outline the nature of the injury or condition and provide other relevant details such as date of occurrence and whether the injury occurred at work.