Page 2

41 fields

Fields on page 2

Mrs

Miss

Q1.App SalutOther

Dr Mr Mrs Miss Ms Mx Other Family name

First given name

Second given name

Your date of birth

date of birth (DD MM

birth (DD MM YYYY)

0 0 3 6 0

Male

Female

Non-binary

Indeterminate or intersex

Prefer not to say

Male

Female

Intersex

Your residential address in Australia

Q6.App Add3

Postcode

Your postal address in Australia (if different to above)

Q6.App PostalAdd3

Postcode

Your previous residential address in the last 3 years

Q6.App PrevAdd3

Postcode

Daytime phone number (including area code)

Mobile phone number

get an IHI for myself

younger than 14 years of age

amend my personal details for an existing IHI

years of age

Page 3

62 fields

Fields on page 3

Yes

Family name

First given name

Second given name

Date of birth (DD

of birth (DD MM YYYY)

(DD MM YYYY)

Gender Male

Female

Non-binary

Indeterminate or intersex

Prefer not to say

Sex at birth Male

Female

Intersex

Family name

First given name

Second given name

Date of birth (DD

of birth (DD MM YYYY)

(DD MM YYYY)

Gender Male

Female

Non-binary

Indeterminate or intersex

Prefer not to say

Sex at birth Male

Female

Intersex

Mrs

Miss

Other

Dr Mr Mrs Miss Ms Mx Other Family name

First given name

Second given name

Date of birth (DD

of birth (DD MM YYYY)

(DD MM YYYY)

Gender Male

Female

Non-binary

Indeterminate or intersex

Prefer not to say

Sex at birth Male

Female

Intersex

Sex at birth Male Your residential address in Australia

Your residential address in Australia

Q10.Exist Add3

Postcode

Your postal address in Australia (if different to above)

Q10.Exist PostalAdd3

Postcode

Daytime phone number (including area code)

Mobile phone number

Page 4

38 fields

Fields on page 4

Mrs

Miss

Other

Dr Mr Mrs Miss Ms Mx Other Family name

First given name

Second given name

Date of birth (DD

of birth (DD MM YYYY)

(DD MM YYYY)

Gender Male

Female

Non-binary

Indeterminate or intersex

Prefer not to say

Sex at birth Male

Female

Intersex

Sex at birth Male Your residential address in Australia

Your residential address in Australia

Q11.New Add3

Postcode

Your postal address in Australia (if different to above)

Q11.New PostalAdd3

Postcode

Daytime phone number (including area code)

Mobile phone number

Signature0

Date (DD MM YYYY)

(DD MM YYYY)

YYYY)

Healthcare Federal · MS003

Request an Individual Healthcare Identifier (MS003)

This form is used to apply for an Individual Healthcare Identifier (IHI) when you're not eligible for Medicare or DVA benefits.

Issued by: Services Australia
Form number: MS003
Jurisdiction: Federal
Length: 4 pages

When do you need this form?

You need this form when you or your dependent child under 14 years old requires healthcare services in Australia but are not eligible for Medicare or Department of Veterans' Affairs benefits. You can also use this form to update personal details on an existing IHI if you fall into these categories.

What you'll need

One certified document from the Primary group (Australian passport, foreign passport with valid visa, Australian driver licence, government photo ID, or Australian birth certificate)
Or two certified documents from the Secondary group (foreign government documents, student ID cards, academic transcripts, or bank cards)
Additional certified documents if amending personal details (change of name certificate, marriage certificate, or passport)
Personal details for yourself or your dependent child under 14 years old

Where to send it

The form should be submitted to Services Australia's Healthcare Identifiers Service. You will receive a letter confirming the outcome of your application.

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