Your email
*
example@example.com
Type of support provided
Please Select
Face to face with travel
Face to face without travel
Online
Travel method
*
Please Select
Motor Vehicle (own)
Motor Vehicle (shared)
Public Transport
Push Bike
E-Bike
Walking
Not applicable
Support full name
*
Enter your name or the names of the support team member for the period related to the participants session/s.
Participant name/s
*
If delivering a MYCare group session with multiple participants please enter first names with commas.
Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Finish Time
*
Hour Minutes
AM
PM
AM/PM Option
Support Delivery Start Date
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date support started
Support Delivery End Date
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date support ended
Support Notes
*
Please include day of the week, dates, start / finish times what you did, where you went & when & how the supports helped the participants goals. Please include amounts participant spent using their own money and attach receipts of their purchases.
Claim Reference Number
*
Please use the participants initials followed by your initials & the date of supports. Eg YNPN220222. For group sessions please use your initials & a capital G followed by the date of supports. Eg YNG220222.
Service Description
*
Please Select
Mindful Disability Supports, Community Access, self care & Skill development - Weekday Support Item: 01_011_0107_1_1
Mindful Disability Supports, Community Access, self care & Skill development - Saturday Support Item: 01_013_0107_1_1
Mindful Disability Supports, Community Access, self care & Skill development - Sunday Support Item: 01_014_0107_1_1
Mindful Disability Supports, Community Access, self care & Skill development - Public Holiday Support Item: 01_012_0107_1_1
Mindful Disability Supports, Community Access, self care & Skill development - Weekday Support Item: 04_104_0125_6_1
Mindful Disability Supports, Community Access, self care & Skill development - Saturday Support Item: 04_105_0125_6_1
Mindful Disability Supports, Community Access, self care & Skill development - Sunday Support Item: 04_106_0125_6_1
Mindful Disability Supports, Community Access, self care & Skill development - Public Holiday Support Item: 04_102_0125_6_1
Mindful Disability Supports, Community Access, self care & Skill development Support item: 15_037_0117_1_3
Mindful Disability Supports, Community Access, self care & Skill development Support item: 09_009_0117_6_3
Assessment Recommendation Therapy or Training - Psychologist: 15_054_0128_1_3
Assessment Recommendation Therapy or Training - Counsellor: 15_043_0128_1_3
Assessment Recommendation Therapy or Training - Physiotherapist: 15_055_0128_1_3
Assessment Recommendation Therapy or Training - Other Professional: 15_056_0128_1_3
Assessment Recommendation Therapy or Training - Dietitian: 15_062_0128_3_3
Assessment Recommendation Therapy or Training - Exercise Physiologist: 15_200_0126_1_3
Assessment Recommendation Therapy or Training - Exercise Physiologist: 15_200_0128_1_3
Assessment Recommendation Therapy or Training - Occupational Therapist: 15_617_0128_1_3
Supports in Employment - Weekday Daytime 04_801_0133_5_1
Supports in Employment - Weekday Evening 04_802_0133_5_1
Supports in Employment - Saturday 04_803_0133_5_1
Supports in Employment - Sunday 04_804_0133_5_1
Supports in Employment - Public Holiday 04_805_0133_5_1
Transition Through School And To Further Education 13_030_0102_4_3
Employment Related Assessment And Counselling 10_011_0128_5_3
Employment Assistance 10_016_0102_5_3
Supports in Employment - Weekday Daytime 10_806_0133_5_1
School Leaver Employment Supports 10_021_0102_5_3
Support Coordination Level 1: Support Connection 07_001_0106_8_3
Support Coordination Level 2: Coordination of Supports 07_002_0106_8_3
Support Coordination Level 3: Specialist Support Coordination 07_004_0132_8_3
Psychosocial Recovery Coaching - Weekday Daytime 07_101_0106_6_3
Psychosocial Recovery Coaching - Weekday Evening 07_102_0106_6_3
Psychosocial Recovery Coaching - Weekday Night 07_103_0106_6_3
Psychosocial Recovery Coaching - Saturday 07_104_0106_6_3
Psychosocial Recovery Coaching - Sunday 07_105_0106_6_3
Psychosocial Recovery Coaching - Public Holiday 07_106_0106_6_3
Respite STA And Assistance: 1:1 ratio
Respite STA And Assistance: 1:2 ratio
Respite STA And Assistance: 1:3 ratio
Respite STA And Assistance: 1:4 ratio
Quantity of Support Hrs
*
Please write these to 2 decimal places. eg 2hrs 30mins would be 2.5hrs, 2hrs 45mins would be 2.75hrs please calculate to the nearest 0.25hrs and include your reporting time.
Travel time
*
Please Select
0.0
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0.55
0.6
0.65
0.7
0.75
0.80
0.85
0.90
0.95
1
We pay travel time to the participant and from participant to another participant and home from last participant of the day to a maximum of 0.5hrs in a given journey unless otherwise specified. Leave blank for online sessions.
Hourly Amount
*
Please see relevant fees per hour above.
Travel Hourly Amount (
Please see relevant fees per hour above.
Starting Vehicle Odometer reading
*
End Vehicle Odometer Kilometres Reading - upon direct return to usual business address from last participant or vehicle odometer reading prior to departure from client.
*
Kilometers
Please claim kilometers traveled to and from the participant & whilst with the participant unless otherwise specified in writing.
Additional Expenses
Please provide receipts for parking & tolls.
Session total earnings calculation
Tax Invoice total
*
Please upload additional expenses receipts, photos of participant recepits for purchases, photos, cancellation evidence if any and Kilometers evidence eg. Start & End Speedometer photos, Log book details, Google maps timeline
Browse Files
Drag and drop files here
Choose a file
Please add screenshot or photo of receipts for us to pay additional expenses.
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Kilometres Line item : 01_799_0107_1_1 | 04_799_0125_6_1 | 15_799_0117_1_3
*
Please select the appropriate Kilometers line item for support. Eg 01_799_0107_1_1
Should be Empty: