Queensland Government
Queensland Health
Queensland Government
Queensland Health
Services > Statewide > Medical Aids Subsidy Scheme

MASS Application and Information forms

General
Communication Aids
Continence Aids
Mobility and Daily Living Aids
Orthoses and Medical Grade Footwear
Oxygen
Spectacle Supply Scheme

Cystic Fibrosis Program

 

All MASS forms may be completed on the screen, saved (& re-used) then printed out to forward to MASS (or printed out and used as handwritten forms).  Refer to the eform user guide for tips on their use.  Use the PDF versions if you prefer to hand write your applications, or dont have MSWord.

General

Form Version Word  PDF
MASS 70 Acquittal Form                                                                                     Jul 2010    Microsoft Word   PDF Version
MASS 80 Supplier Performance Report  Jul 2010    Microsoft Word   PDF Version
MASS 81 Client Satisfaction Feedback Form  Jul 2010    Microsoft Word   PDF Version
MASS 83 Accident and Incident Report  Jul 2010    Microsoft Word   PDF Version
MASS 84 Concession Card Confirmation Form  Jul 2010    Microsoft Word   PDF Version

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Communication Aids

Form Version Word PDF
MASS 21 Communication Aids Application Form                                      Sep 2010    Microsoft Word   PDF Version
MASS 21 App SGD Speech Generating Device Application Form Appendix Jul 2010   Microsoft Word

  PDF Version

MASS 21 App AL Artificial Larynx Application Form Appendix Aug 2011   Microsoft Word 

  PDF Version

MASS 21 App CS Communication Software Application Form Appendix Aug 2011   Microsoft Word

  PDF Version

MASS 21 App VAD Voice Amplification Device Application Form Appendix Sep 2009   Microsoft Word

  

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Continence Aids

 Form  Version Word  PDF
 MASS 50 Continence Aids Application Form                                                            Oct 2012     PDF Document
 MASS 55 Continence Aids Client Re-Application Form Jul 2010  Word document   PDF Document

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Mobility and Daily Living Aids

 Form Version  Word  PDF
 MASS 20 Mobility and Daily Living Aids Application           Jun 2011    Word document  PDF Document
 MASS 20 URGENT Equipment Services Urgent Processing Justification Form    Feb 2010   Word document  PDF Document
 MASS 20 DLA Short Form Sep 2009   Word document  PDF Document
 MASS 20 MWC Short Form Sep 2009   Word document  PDF Document
 MASS 20 WWA Short Form Jun 2012   Word document  PDF Document
 MASS 23 Bathboard Specification Form Sep 2009   Word document  PDF Document
 MASS 82 Consent for Photograph/Video Form Sep 2009   Word document  PDF Document
 Home Access and Safety Checklist for Powerdrive Wheelchairs Sep 2009   Word document  
 Hoist & Sling Compatibility Checklist Apr 2010   Word document  
Request for Trial Equipment from MASS Stock Flow Chart  May2013     Flow Chart 
MASS 26 Request for Trial MASS Stock Equipment May2013   MASS 26
 MASS 85 Permanent Loan Information Sheet Oct 2009     PDF Document
   

  

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Orthoses and Medical Grade Footwear

 Form  Version  Word PDF 
MASS 60 Orthoses and Medical Grade Footwear Application Form May 2011    Mass 60 Word document   Mass 60 PDF
MASS 60 App MGF Medical Grade Footwear Supplier Information Form Appendix  Sep 2009   Mass 60 MGF Word   Mass 60 MGF PDF
MASS 60 App ORT Orthotist Information Form Appendix  Sep 2009   MASS 60 Ortho Doc   Mass 60 ortho PDF

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Oxygen

 Form  Version  Word

 Print only

MASS 45 Adult Oxygen Initial and 4 month Application Form                                 Nov 2011                    Mass 30 PDF
MASS 45 App Adult Oxygen Information and Safety Form    Appendix                      Apr 2010       Mass 45 app word         Mass 45 app pdf
MASS 46 Adult Oxygen Annual Re-Application Form Feb 2012                Mass 46 pdf
MASS 47 Paediatric Oxygen Application Form Nov 2011                Mass 47 pdf
MASS 47 App Child Oxygen Information and Safety Form Appendix Sep 2009       Mass 47 app word         Mass 47  app pdf
MASS 48 Power Failure Emergency Plan Sep 2009       Mass 48  word         MASS 48 PDF

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Spectacle Supply Scheme

 Form  Version  Word  PDF
MASS 30 Spectacle Supply Scheme Application Form                                                                                 Oct 2010            MASS 30 DF
Spectacle Supply Scheme - Loss/Breakage Declaration                  Spectacle loss and break PDF
       

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Cystic Fibrosis Program

 Form                                                                                                          

 

Version      

Interactive PDF
 MASS 10 CPF Cystic Fibrosis Application Form                                             May 2012           MASS 10 PDF
 FAQ - Cystic Fibrosis Program                                                                           Aug 2011     FAQ CFP PDF

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Last Updated: 22 May 2013
Last Reviewed: 22 May 2013



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