Domiciliary Equipment ServiceDomiciliary Equipment Service
Prescription and Request Forms
Equipment needs to be ordered using a prescription form. Select the correct form, depending on the funding that is being used for the supply of the items.
- Equipment Request Form - DHS Equipment Program (DOC 188.0 KB) (DOCX 207.5 KB)
- Equipment Prescription Form ACH (DOCX 174.3 KB)
- Equipment Prescription Form ACH - Electronic Form (PDF 173.5 KB)
- Equipment Request Form RDNS (DOCX 146.7 KB)
You can order equipment for DHS Equipment Program and Commonwealth Home Support Programme (CHSP) clients using iApply - Equipment Requests.
Home Modifications need to be ordered using a prescription form.
Additional specifications may be required for more complex prescriptions, and these should be provided to DES using the relevant specification forms in addition to a prescription form. This enables DES to ensure that the appropriate item is provided to meet an individual need.
All prescription and request forms can be faxed to DES on 1300 295 839 or emailed to firstname.lastname@example.org.