Hospital Forms
Medibank has sought permission to provide the following frequently used Certificates. For your convenience these can used if applicable to your contractual arrangement with Medibank.
Hospital forms currently available:
- Intensive Care Certificate
- Coronary Care Certificate
The certificates are to be completed with reference to the Instructions for use. The certificates should be used in conjunction with the relevant guidelines developed and issued by the Joint NSW Health Insurer/ Private Hospital Working Party and are used by all States and Territories.
Intensive Care Certificate
- This certificate can only be used in hospitals with a licensed intensive care unit.
- This certificate is required where additional health fund Critical Care benefits are sought for patients admitted to an Intensive Care Unit at a private hospital.
- Do not use this certificate for patients admitted to a Coronary Care Unit. A separate certificate is used for these patients.
Intensive Care Certificate
Coronary Care Patient Certificate
- This certificate is required where additional health fund Coronary Care benefits are sought for patients admitted to a Coronary Care Unit at a private hospital.
- This certificate is used by health funds for reimbursement purposes to establish the complexity of a patient's care in a Coronary Care Unit, in accordance with individual hospital / health fund contracts.
- Do not use this certificate for patients admitted to an Intensive Care Unit. A separate certificate is used for these patients.
Coronary Care Certificate Instructions for Use Technical Term Explanation