Capital sensitivity
INNER REGIONAL AUSTRALIA EXEMPTION APPLICATION FORM
Exemptions are only available if a practice is located in the Remoteness Area (RA) category
inner regional area (RA2), where the location was previously under the Rural, Remote and
Metropolitan Area (RRMA) classification system, RRMA4 or RRMA5, and:
 the diagnostic imaging equipment does not exceed the maximum extended life age by
three years or more;
 the equipment is operated on a rare and sporadic basis; and
 the equipment provides crucial patient access to diagnostic imaging services.
Practices located in the RA categories of outer regional (RA3), remote (RA4) and very remote
(RA5) are automatically exempt and do not need to apply. There are no exemptions for
practices located in the RA category of major cities (RA1).
Practices can identify which RA they fall under at DoctorConnect.
Once completed, this form should be forwarded to the Department of Health, preferably by
e-mail or by mail to:
Secretary
c/ Diagnostic Imaging Section
Medical Specialists Services Branch
Medical Benefits Division
Department of Health
MDP 850
GPO Box 9848
CANBERRA ACT 2601
1. Information about the practice and location
LSPN
PROPRIETOR NAME
PRACTICE NAME
CONTACT PERSON
PHONE NUMBER
EMAIL ADDRESS
STREET ADDRESS
SUBURB/POSTCODE
STATE
RA
RRMA
RA2
RRMA4 or RRMA5
For more information see: Department of Health - Capital Sensitivity
2. The equipment must not exceed the maximum extended life age by more than 3 years
EQUIPMENT TYPE
Date of manufacture or date first installed in Australia
1
2
3
4
5
6
3. The equipment is operated on a sporadic or rare basis (i.e. low volume of services
provided to patients)
EQUIPMENT TYPE
2011
Number of
services
2012
Number of
services
2013
Number of
services
2014
Number of
services
(to date)
1
2
3
4
5
6
4. Provide an outline of the type of crucial patient access against each type of equipment
for which an exemption is sought
For more information see: Department of Health - Capital Sensitivity