Transcription of MASS84 Proxy Access to Centrelink Information
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MASS84 Proxy Access to Centrelink Information
(Affix identification label here). Medical Aids Subsidy Scheme The State of Queensland (Queensland Health) 2012 Contact Queensland Health Family name: MASS 84. Proxy Access to Centrelink Given name(s): Information Date of birth: Gender: M F I. This form is used for applicants to provide consent to Medical Aids Subsidy Scheme (MASS) staff to use Centrelink Confirmation eServices (CCeS) to verify eligibility. This consent will be used for the sole purpose of authorising Centrelink to provide Information to MASS to determine your eligibility in relation to assistance or services provided by MASS.
Please attach copy evidence to confirm authority e.g. copy of Enduring Power of Attorney to this form. Email OR Post completed form to a MASS Service Centre Email: MASS184@health.qld.gov.au Website: health.qld.gov.au/mass Brisbane: PO Box 281, Cannon Hill Q ld 4170 Telephone: 07 3136 3636 Townsville: PO Box 980, Hyde Park Q ld 4812
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