Start a paper application for a patient

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CLICK HERE to download a copy of the paper (new and renew) application form.

Please note, only use this form if the Accessible Parking Permit portal is off-line, or you cannot verify your AHPRA details, or if the applicant does not have a mobile number.

The paper application form requires a longer processing time for the Medical Practitioner as well as Council, resulting in a possible delay in outcomes for your patient.

It is not advised that a copy of the form is saved on your local computer/s. This form may be updated regularly and old forms will become invalid.

STEP ONE

The following information need to be entered either by the patient, nominated representative or yourself

  • Apply for an Accessible Parking Permit
  • Renew an existing Accessible Parking or Disabled Parking Permit

STEP TWO

Enter the patient Personal Details

  • First name
  • Middle name(s) (optional)
  • Family name
  • Date of birth
  • Gender

STEP THREE

Enter the patient Contact Details

  • Email address (optional)
  • Mobile number (this will be used for SMS communication regarding the patient’s application)
  • Landline
  • Residential address (this must be your current home address, not a PO Box. It must be located in Victoria)
  •  Driver or passenger or both


STEP FOUR

Skip this step if there is no nominated representative.

If the patient has a nominated representative, the representative will need to fill out the following information (the nominated representative is the person who is assisting the applicant)

  • First name
  • Family name
  • Relationship to the applicant
  • Email address(optional)
  • Mobile number
  • Outcome delivery preference

STEP FIVE

If a patient is renewing a permit, enter the following information. Otherwise skip this step.

  • Permit number
  • Permit type
  • Permit expiry date
  • Issuing council

STEP SIX

The patient and/or the nominated representative should read the Applicant/Nominated Representative Declaration before entering the following information

  • Name
  • Signature
  • Date
  • Tick either ‘I am the applicant’ or ‘I am the applicant’s nominated representative’


STEP SEVEN

The Medical Practitioner will enter their details before completing the Functional Assessment

  • Practitioner first name
  • Practitioner family name
  • AHPRA registration number
  • Practice name
  • Practice street address
  • Practice phone number
  • Practice email address (optional)


Occupational therapist please note: If your client is seeking a permit on the basis of a cognitive, behavioural or neurological impairment which is associated with the requirement for the continuous support of another person in order to maintain their safety, then please refer the applicant to their GP for assessment.

STEP EIGHT

To complete the functional assessment, answer the following patient questions:

  • How have you verified the patient’s identity?
  • Does the patient drive a vehicle or are they a passenger only?
  • Does the person have a significant mobility impairment such that they are required to use a mobility aid or device and that a parking bay (not designed for people with disabilities) is insufficient in size to allow them access to and from their vehicle?
  • If yes, which mobility aid does the patient use?
  • Does the patient’s significant cognitive, behavioural or neurological impairment mean they are unable to independently mobilise safely without the continuous support of a person (or carer)?
    An occupational therapist cannot assess yes for a client
  • Select the option that best describes the patient’s ability to walk
  • Approximately how long will the patient’s mobility impairment last?

STEP NINE

Read Permanent Medical Condition/ Disability Classification. Based on this definition answer the following question:


Does your patient or client have a permanent medical condition or disability? Yes or No





STEP TEN

Read the Practitioner Declaration before entering the following information

  • Name
  • Signature
  • Date