Requesting the following forms, letters, plans or Agreements
Form or letter detailing all medications needed
Medication Agreement Form ($35)
Medication Letter for Customs & overseas travel;
Webster Packs instructions.
Letter to support request for compounding of a medication($35)
Authorisation for early dispensing of a script repeat ($35)
Seizure Management Plan ($35)
Seizure Management Plan with Midazolam ($35)
Medication Purpose Form for the NDIS ($40)
To make a request,
Submit our Request Form below
We send an invoice.
For Medication Agreement Forms, Customs Letters, or Webster Pack Instructions, we also send the appropriate South Australian DECD Medication Agreement Form as an editable WORD doc for you to complete. This allows you to detail all the Medications your child needs to take that should be included. Once completed, please send it back to us by email.
The provided form has been modified to make it easier for you and your doctor to complete.
The medication name, strength, dose and form (liquid, capsules etc) and time of administration should be detailed.
Some fields have drop-down boxes, and others auto-populate to avoid tedious repetition.
For Medication Agreement Forms, please also complete all the Guardian/Parent sections to provide all the details.
For other forms or letters concerning a particular medication, please detail the medication (name, strength, dose, etc).
Pay the invoice.
Your doctor then, either in or outside an appointment, completes and sends the Plan, letter or Agreement to you by email.
For Medication Agreements, Customs Letter or Webster Pack instructions, the doctor uses the medication details provided on the Word format DECDS form.
For Medication Agreements, the doctor checks the medication details you have detailed in the DECDs Form and then signs the form and sends it to you.
For the Customs/Travel Letter or Webster Pack Instructions, the doctor checks and uses the medication details you have provided in the DECDS Form to complete the letter.
Your doctor may require an appointment to complete the request, and we will send an offer or phone to organise this. If an appointment is needed, your provider may adjust the fee to accommodate the Request Fee that has already been paid. Whether the doctor requires an appointment or adjusts the associated fee is a matter for their discretion.
When completing the DECDs form for Medication Agreements or letters, for each medication:
provide the name, strength and form (e.g., liquid, capsules, tablets, topical (such as cream or ointment), inhaler, injection etc.);
amount of the medication for each dose (e.g., 1.5 tablets, 5 ml, 2 drops, etc.)
the time the medication dose should be given (this time will be include giving the medication up to 30 minutes before or after the nominated time);
How it is administered.
The fee must be paid to proceed with the Request.
The fee is $40 for a Medication Purpose Form and $35 for any other Request for an Agreement, Plan or letter, including one or more medications.
and if required urgently, an additional charge of $40 (within 5 business days or your provider’s next clinic, whichever is the latter).
If, instead of an email, posting, or faxing of a paper form or letter is requested, an additional charge of $15.00 will apply.
Please phone to make the payment, or email a copy of your bank’s remittance advice to show the payment. We will send a receipt.
The fee is billed to cover the costs of the significant work involved in processing and completing the Request, including both administrative and medical work. An appointment may be required if the doctor feels the Request involves more complexity.
Do I need my Specialist to complete the required form or letter?
Your GP can normally complete these Medication Forms and Letters. Check with them to see if they are happy to do so.
Parents can generally complete the following:
Medication Agreement Forms for as-needed or occasional pain relief such as Panadol or Nurofen, Melatonin, antiseizure medications (not Midazolam), Fluoxetine, asthma medications, Clonidine and other non-Schedule 8 Medications.
Seizure Management Plans (not requiring administration of Midazolam).
Medication Agreement Forms: Your Specialist or GP must complete the medical section of the Form for Schedule 8 controlled drugs such as Opioids, Stimulants, Oxygen, Insulin, and regular pain relief.
Seizure Management Plans: The Specialist Paediatrician, Neurologist, or Neurology Nurse must complete a Plan involving the use of Midazolam. These specialists should also complete a Plan not requiring Midazolam where the seizure type requires a non-standard first aid response, where a parent or guardian requires support to complete this form, or a private school or centre requires this.