Medicare Enrolment Application (Australia) – Enrol in Medicare, Re-enrol/Extend Eligibility, Enrol a Newborn, and Register for My Health Record Completed Form Examples and Samples
View completed examples of the Australian Medicare Enrolment Application form. Our samples cover new enrolments, re-enrolment, extending eligibility, adding a newborn, and registering for My Health Record to help you fill out your form correctly.
Medicare Enrolment Application Example – New Permanent Resident Family & Newborn
How this form was filled:
This example shows a completed Medicare Enrolment Application for a family who recently became permanent residents of Australia. It includes details for two adults and their Australian-born newborn, demonstrating how to enrol multiple family members simultaneously, register for My Health Record, and provide bank details for benefits.
Information used to fill out the document:
- Primary Applicant Name: Liam Chen
- Primary Applicant DOB: 15 May 1994
- Spouse's Name: Mei Lin
- Spouse's DOB: 20 August 1995
- Newborn's Name: Olivia Chen
- Newborn's DOB: 10 January 2026
- Residential Address: 42 Wallaby Way, Sydney NSW 2000
- Date of Arrival in Australia: 01 December 2025
- Visa Type: Permanent Resident Visa (Subclass 189)
- Passport Country: China
- Contact Phone Number: 0412 345 678
- Contact Email: [email protected]
- Bank Details (BSB): 062-000
- Bank Details (Account No): 1234 5678
- My Health Record Registration: Yes, for all family members
- Australian Organ Donor Register: Yes, for both adults
- Application Date: 25 January 2026
What this filled form sample shows:
- Correct completion of details for multiple applicants (2 adults, 1 newborn) on a single form.
- Demonstrates how to provide permanent residency visa information as proof of eligibility.
- Includes the addition of a newborn child, a common requirement for new families.
- Shows consent for registration to both My Health Record and the Australian Organ Donor Register.
- Properly filled bank account details to receive Medicare benefits directly.
- All dates and information are current for 2026, providing a relevant example.
Form specifications and details:
| Form Name: | Medicare Enrolment Application (MS004) |
| Use Case: | First-time enrolment for new permanent residents and their Australian-born newborn. |
| Country: | Australia |
| Governing Body: | Services Australia |
Created: February 10, 2026 11:05 PM
