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T - 1300 36 55 66
M - 0493 576 512
Email: info@carendis.au
CARENDIS SERVICES PTY LTD
Ingleburn, NSW 2565
Applying to access the NDIS
Patients and/or carers can make an access request by:
- calling 1800 800 110 and providing details over the phone (this is called a verbal access request)
- downloading and completing an Access Request Form (this can be mailed out upon request).
The application will only be progressed once the patient also submits adequate evidence detailing their impairment and its functional impact (e.g. copies of existing reports, letters and/or assessments from treating professionals, support workers, family members and carers).
The role of the treating professional is to provide objective evidence that the patient has a permanent impairment that results in substantially reduced functional capacity in one or more of the following areas: mobility, communication, social interaction, self-management, learning and self-care.
You can provide this information by:
- completing the ‘Treating Professional’ section of the Access Request Form (Part F of the current Access Request Form); and/or
- attaching relevant reports, letters and/or assessments from one or more treating professionals, if you feel this information is already adequately detailed elsewhere. This may include preparing your own letter/report to
- (i) clearly articulate the diagnosis (i.e. nature of the impairment resulting in disability) and likely permanence, and
- (ii) outline its functional impact and the types of support required.
If your patient has a psychosocial disability, you can also choose to complete the Evidence of Psychosocial Disability Form (PDF 482KB), which has prompts specific to psychosocial disability to help you detail the information required.
In this case, you should clearly mark on the Access Request Form that an Evidence of Psychosocial Disability Form is attached.
As a GP, you need to decide if you are the right treating professional to be providing this information.
If you do not have enough information on file or you don’t fully understand the functional impact of a patient’s impairment, you may need to reach out to other treating professionals (e.g. specialist doctor, allied health professional) for copies of existing reports, letters and/or assessments.
Alternatively, if you believe another treating professional is better placed to articulate the functional impact of the patient’s impairment and the types of support required, you may choose to refer the patient on to this professional for the support they need to access the NDIS.
Requesting costly new assessments from allied health professionals or other specialists is not required if sufficient evidence of impairment and its functional impact already exists.
Please refer to our ‘Who can help?’ brochure for advice on who can assist you in the task of evidence gathering:
Treating professionals are required to provide the following information:
- name of medical condition and resulting impairment
- date of diagnosis and how long your patient’s functional capacity has been affected by the impairment
- indicate if the condition is terminal or degenerative in nature.
You should also attach any existing evidence from the patient’s file that confirms the diagnosis (a letter of diagnosis is often the best way to provide evidence of an impairment).
If the patient has more than one disability, you only need to provide this information for their ‘primary disability’, i.e. the disability with the greatest functional impact day-to-day.
However, you should list any other (secondary) disabilities that also impact their day-to-day function.
For the purposes of the NDIS, an impairment is permanent if it has not been, and is unlikely to be, substantially alleviated by conventional treatments.
Therefore, in your response, it is important to summarise a patient’s treatment journey to date, i.e. list past and current treatment, along with duration/frequency and treatment response/outcomes.
Future treatment options and the patient’s likely response to them should also be explained.
Not having tried all conventional treatments does not automatically preclude a patient from joining the NDIS. If any available treatments have been deemed unsuitable for your patient, attach your clinical rationale to the form.
The six NDIS functional domains (mobility, communication, social interaction, self-management, learning and self-care) aim to capture how a disability impacts upon all aspects of a patient’s life.
They provide a practical and holistic framework within which to contextualise a person’s disability and to understand the type and level of support an individual requires to live well.
When filling out this section of the Access Request Form, you only need to complete the domains which are significantly impacted by the patient’s impairment.
For example, the patient may have substantially reduced function when completing mobility and self-care activities. However, the other domains may be unaffected or only minimally affected.
The NDIS assessor requires relevant and objective evidence that the patient’s impairment has resulted in substantially reduced functional capacity in one or more of the following areas: mobility, communication, social interaction, self-management, learning and self-care.
For each affected life area (‘functional domain’), describe in simple terms:
- what the patient cannot do without support due to their impairment (provide clear examples);
- how this impacts their day-to-day function, employment and/or interaction with peers and the wider community;
- what supports are already being received (from family/carers, services and community) and how the patient has or has not benefitted;
- the type and intensity/frequency of supports needed and how they will build functional capacity and/or halt the progression of the impairment; and
- how these supports will improve social and economic participation.
When completing your response, it is important to remain focused on describing the impairment and its impact, not just the medical condition which led to the impairment.
For example, simply stating that the patient had a below-knee amputation due to vascular complications from Type 2 diabetes does not provide sufficient detail for the assessor.
In this instance, it’s also important to state that this physical impairment has led to unstable mobility, so they need help showering, shopping, etc.
If your patient has a List A condition, you do not need to provide information about functional status unless specifically requested. However, evidence related to diagnosis and treatment is still required.
If you don’t have a good understanding of how a patient’s day-to-day function has been affected by their impairment, you may need to have this conversation with the patient and/or their carer as part of a longer consultation.
Having them run you through a typical day in their life, while outlining the challenges they experience and the different kinds of help they require to complete ordinary tasks of daily living (e.g. dressing, preparing a meal, getting groceries) is a good place to start.
You will also want to explore with them how their ability to work, socialise and participate in community life is affected.
This 1:1 discussion can be a particularly effective approach for identifying other areas in which a patient could benefit from disability supports – in addition to the types of support that initially motivated the patient/carer to seek NDIS access.
This conversation may also help the patient or carer to open up about functional issues they are sensitive about or reluctant to disclose.
Within the primary care environment, practice nurses can be a useful resource for eliciting this information for you.
For example, by meeting with the patient and/or carer first, the practice nurse can gain a more detailed understanding of the day-to-day challenges faced by the patient as a result of their impairment.
They can then document these insights and help you identify what practical supports are required. Practice nurses can also assist you to request/collate existing evidence from other professionals, e.g. assessments, reports.
This information helps confirm the patient’s eligibility for the Scheme.
It also facilitates the subsequent planning process by providing a starting point for discussions between the NDIA planner and patient about the types and level of support required on a daily basis.
Common types of support that may be required include:
| Mobility and motor skills | Communication | Social interaction | Learning | Self-care | Self- management |
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Where possible, avoid using clinical or medical terminology. Use plain English and frame your responses in terms of what activity limitations the patient experiences day-to-day due to their impairment.
A gold standard example is shown below:
EXAMPLE (Functional Domain: Learning)
Kris has difficulty understanding and remembering information and then translating that into actions or tasks. He is unable to learn and remember the tasks associated with going shopping by himself, or cooking, or being able to predict what is going to happen next and organise information in a logical way to make his decisions. Kris is unable to be left alone within his home or the community as he needs supervision constantly to ensure his safety in all these environments. He requires a support person to be with him to assist him to understand when he is interacting with others in the community.
The above example outlines:
- Specific Learning Activities Affected by Disability:
‘He is unable to learn and remember the tasks associated with going shopping by himself, or cooking, or being able to predict what is going to happen next and organise information in a logical way to make his decisions.’
- Type of Support Needed
‘He requires a support person…’
- Level/frequency of Support Needed
‘Kris is unable to be left alone within his home or the community as he needs supervision constantly…’
You do not have to write narrative style – bullet points are fine. As the Access Request Form is refined over time, you are likely to see more checkboxes introduced making the response process easier.
Doctors who prepare their own written report are less likely to receive requests for further information.
In providing evidence to support an Access Request, it is reasonable to expect that GPs will perform an examination of some description to assess or confirm the patient’s current medical condition. If the time taken to assess and provide information to support an Access Request is part of this consultation, it may be claimed under a Medicare item.
Consistent with the operation of the Medicare Benefits Schedule, generally it is at a GP’s discretion to select the Medicare item number that most appropriately reflects the nature of the consultation.
When a GP provides details about a patient without an associated consultation and without the patient present, a Medicare rebate is not payable.
A GP may use Medicare Items for a GP Management Plan and a Team Care Arrangement to identify and communicate with allied health and other professionals about the patient seeking access. Central and Eastern Sydney PHN has also developed this resource on MBS billing practices for GPs .
When completing the ‘Treating Professional’ section of the Access Request Form (Part F of the current Access Request Form), keep the following in mind:
- Make sure you provide sufficient evidence to validate the diagnosis of a disabling condition, e.g. attach a letter of diagnosis.
- Make sure you provide sufficient evidence that the impairment is permanent. For the purposes of the NDIS, an impairment is permanent if it has not been, and is unlikely to be, substantially alleviated by conventional treatments. Therefore, it’s important to adequately detail the patient’s treatment history.
- Make sure you adequately describe the functional impact of the impairment. For each affected functional domain (mobility, learning, communication, self-care, social and self-management), consider what activity limitations the person experiences everyday as a result of their disability. You only need to provide this information for the domains that are significantly impacted (this may be one or more).
- Don’t forget to provide evidence of how the impairment has affected the patient’s ability to participate in school/study, work or the wider community (to clearly demonstrate its social or economic impact).
- Consider whether you are the most relevant treating professional to provide this information and if not, identify which professional/s you can reach out to for this information (or refer the patient on to for the extra support they need to complete the access request).
Eligibility and medical conditions
A person may satisfy the NDIS access requirements regardless of whether their impairment came about through birth, disease, injury or accident.
To be eligible for NDIS funding, the disease or medical condition must cause permanent impairment (physical, intellectual, cognitive, neurological, visual, hearing or psychosocial), resulting in significant disability.
For example, stroke leading to hemiparesis (the resulting physical impairment substantially reduces mobility) or severe emphysema causing irreversible lung damage (chronic dyspnoea substantially reduces mobility, self-care and participation in community life).
People diagnosed with List A medical conditions are likely to meet the disability requirements because these conditions, by their very nature, are considered to cause permanent impairment and disability resulting in substantially reduced functional capacity.
If your patient has one of these conditions, you only need to provide evidence that they have the condition, and that it has been diagnosed and assessed as per any criteria outlined in List A (e.g. cerebral palsy assessed as Level 3, 4 or 5 on the Gross Motor Function Classification System – GMFCS).
You do not have to provide further information about its functional impact unless specifically requested.
People diagnosed with List B medical conditions are considered to have a permanent impairment.
However, as the severity of the impairment is variable, they will need to demonstrate that as a result of their impairment:
- they have substantially reduced functional capacity or psychosocial functioning;
- their capacity for social or economic participation is affected; and
- they are likely to require support under the NDIS for the duration of their lifetime.
The NDIS will not provide funding or supports for time-limited (non-ongoing) conditions.
For example, reduced mobility due to an acute injury such as a lower limb fracture will not meet the NDIS disability requirement, as the condition is likely to resolve.
The NDIS will also not provide funding or supports for chronic health conditions that are not related to a person's disability. In this regard, it is important to differentiate treatment and care of chronic health conditions and associated comorbidities from disability.
For example, the NDIS may fund disability supports for a person who has had a lower limb amputation due to peripheral artery disease in the setting of diabetes (physical impairment resulting in disability secondary to a health condition), as long as they meet all of the access requirements.
However, the NDIS will not fund medication or medical care relating to the treatment of diabetes or peripheral artery disease.
Psychosocial disability may arise from mental health conditions.
While not everyone who has a mental health condition will experience psychosocial disability, those that do can experience severe effects and social disadvantage.
People with a significant disability that is likely to be permanent may qualify for NDIS support.
For detailed guidance on mental health and the NDIS, please see the Mental health and the NDIS page.
Eligibility and early intervention
Before supporting a patient to complete an access request, we recommend using this 6-point checklist to check their suitability for the Scheme:
Generally speaking, patients must meet three requirements:
- AGE – be aged under 65 years
- RESIDENCE – reside in Australia and be an Australian citizen, or hold a Permanent or Protected Special Category Visa
- DISABILITY OR EARLY INTERVENTION – have a physical, intellectual, cognitive, neurological, visual, hearing or psychosocial impairment that meets either the disability or early intervention requirements.
Your patient must have a physical, intellectual, cognitive, neurological, visual, hearing or psychosocial impairment that:
- is (or is likely to be) permanent
- substantially reduces their ‘functional capacity’ in one or more of the following areas: mobility, communication, social interaction, self-management, learning and self-care
- restricts their ability to participate in work/study, engage with peers and/or interact with their wider community (i.e. has a clear social and/or economic impact)
- requires lifelong NDIS support.
Full guidance can be found in the Access to the NDIS Operational Guideline.
For the purposes of the NDIS, ‘substantially reduced functional capacity’ means that on most days, a person’s impairment significantly limits their ability to manage/perform ordinary activities of daily living across a range of tasks in one or more of the following areas: mobility, communication, social interaction, self-management, learning and self-care.
These six areas are referred to as functional domains.
| Mobility and motor skills | e.g. moving about the home or community, getting in and out of bed or a chair, fine motor skills, gross motor skills.* |
| Learning | e.g. understanding and remembering information, learning new skills, practicing and using new skills. |
| Communication | e.g. being understood in spoken, written or sign language, understanding others and expressing needs and wants by gesture and speech (age-appropriate). |
| Self-care | e.g. showering/bathing, getting dressed, eating or preparing meals, caring for own health |
| Social interaction | e.g. making and keeping friends, interacting with peers or the wider community and coping with related feelings and emotions. |
| Self-management | e.g. doing daily jobs, making decisions, problem-solving and managing money |
*Only includes issues that cannot be solved by commonly used items such as glasses, walking sticks, non-slip bathmats, grab rails and hand-rails installed at stairs.
If an impairment is permanent but its functional impact fluctuates and/or is still in its early stages but expected to worsen over time (e.g. multiple sclerosis), your patient may not meet the disability requirement outlined above.
However, they may meet the Scheme’s early intervention requirements instead. Children younger than six, with developmental delay, may also meet the early intervention requirements.
The purpose of early intervention is to lessen the impact of a person's impairment upon their functional capacity by providing support at the earliest possible stage.
Early intervention support is also intended to benefit a person by reducing their future need for supports and by strengthening the sustainability of their informal supports, e.g. building the capacity of their carer.
Refer children younger than seven with developmental delay or disability to an NDIS early childhood partner.
Find your local early childhood partner.
Under the early childhood approach an early childhood partner provides timely support to ensure that the child and family are able to access the right level of supports they need .
This support may include:
- linking them to activities in their local community and mainstream supports
- information gathering to better understand the child’s development and needs
- developing goals with the family about their child
- delivering short term early intervention, for children with developmental concerns.
- supporting the an access request if the child is likely to meet the access requirements.
In areas where an early childhood partner is not available, contact the NDIS by phone on 1800 800 110, email enquiries@ndis.gov.au or use webchat.
See also Help for children younger than 7.
Refer patients 65 years and over who are looking for disability services and support for the first time to My Aged Care .
Local Area Coordinators (LACs) are local organisations that help deliver the NDIS in the community, for people aged over seven.
This includes assisting NDIS participants to create, implement and review their support plans.
Pre-access, LACs can provide patients with general information about the NDIS, so they can make an informed choice about whether or not to apply for NDIS funding and supports.
LACs can then guide the patient through the process of making an access request. LACs can also help identify whether the supports the patient requires are best provided by the NDIS or other mainstream providers.
Early childhood partners are local organisations that deliver the early childhood approach , supporting children younger than seven with developmental delay or disability.
Early childhood partners are well established in communities and have experience in working with families to connect them with available support. If the child ids likely to meet the access requirements, the early childhood partner will assist the family to apply to the Scheme .
Refer all children younger than seven to an early childhood partner in the first instance.
If there is no early childhood partner in the area where the child lives, contact the NDIS by Phone on 1800 800 110.
See also Help for children younger than 7.
To direct a patient to a LAC or early childhood partner in your local area, please refer to the partner map for your state:
There are a number of other professionals – both within and beyond your practice environment and from both a health and non-health background – who can help you in your efforts to support patients as they navigate access to the NDIS.
Please see our ‘Who can help?’ brochure for more information:
Supporting evidence
Some examples of the different types of evidence that can support a request are shown below:
| Type of evidence | Examples |
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Evidence of disability.
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Functional assessments related to disability
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| Impact of disability on daily life |
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Legislation requires patients to meet specific criteria in order to be eligible for the Scheme and that adequate evidence is provided to demonstrate they fulfil these criteria.
As such, treating professionals are asked to support access requests by providing evidence that helps to validate the type and extent of a patient’s impairment, as well as its permanency and functional impact.
While a mental health care plan may state the patient’s mental health condition (e.g. depression, schizophrenia), it is unlikely to detail the psychosocial impairment that has arisen from that condition.
The NDIS requires an outline and evidence of the specific impairment which has been diagnosed, not just the medical condition.
Find more information and detailed guidance on the mental health and the NDIS page.
Supports
Not all types of support required by a person living with a disability fall under the responsibility of the NDIS .
Some supports are funded by other areas of government (e.g. state health systems) or existing public/community services.
In general, the NDIS will fund reasonable and necessary supports that help a person living with a disability enjoy an ordinary life.
These supports and services fall into three categories.
Core
A support that assists with activities of daily living.
Capital
A support for an investment, such as assistive technologies; equipment and home or vehicle modifications; or funding for capital costs (e.g. to pay for Specialist Disability Accommodation).
Capacity building
A support that helps build independence and skills.
Common examples of supports provided or funded by the NDIS include:
- Help with personal care activities and/or household tasks
- Home and vehicle modifications
- Assistive technology, aids and mobility equipment, including set up and training by skilled personnel
- Transport to enable participation in community, social, economic and daily life activities, e.g. workplace, gym or places of learning
- Support to find and keep a job
- Therapeutic supports like occupational therapy, speech therapy and behaviour support
- Health-related supports (as long as they are a regular part of your patient’s life and the need for them arises from a disability), e.g. continence, diabetic management, dysphagia, epilepsy, nutrition, podiatry, respiratory and wound and pressure care supports (see the Disability-related health supports page for full details).
If you are uncertain if the supports your patient requires are funded by the NDIS, refer the patient to a Local Area Coordinator for further advice before proceeding with an Access Request, as other public or community services may be more appropriate.
The NDIS is not designed to fund supports more appropriately funded or provided by the health system.
Assessment, diagnosis and treatment of health conditions, along with medications and hospital care, remain the responsibility of the health system.
As a general guide, the following health-related services and supports are not provided or funded through the NDIS:
- Items and services covered by the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), nor Medicare gap fees.
- Treatment, services or supports delivered by a doctor or medical specialist, including diagnosis and assessment of a health condition.
- Items and services provided as part of diagnosis, early intervention and treatment of health conditions, including ongoing care of chronic health conditions.
- Medically prescribed care, treatment or surgery for an acute illness or injury including post-acute care, convalescent care and rehabilitation.
- Sub-acute care including palliative care, end of life care and geriatric care.
The Disability Support Pension, along with other income supports and payments such as the Carer Payment, Carer Supplement, Carer Allowance and Child Disability Assistance Paymen,t are entirely separate to the NDIS.
These payments will not be affected if a patient qualifies for NDIS funding (the exception to this is the Mobility Allowance from Centrelink, which may be replaced if your patient’s NDIS plan includes transport-related funded supports).
It’s important to note that someone who is receiving the Disability Support Pension is not automatically eligible for NDIS funding and supports.
Provider
The National Disability Insurance Scheme (NDIS) provides funding to help people with disability achieve their goals, build independence, and participate fully in everyday life. Funding is divided into three main groups - Core Supports, Capacity Building Supports, and Capital Supports.
- Core Supports cover day-to-day assistance such as personal care, community access, and transport.
- Capacity Building Supports focus on developing skills and long-term independence through therapies, behaviour support, and support coordination.
- Capital Supports fund long-term investments like home modifications, assistive technology, and specialist accommodation.
At Carendis Services, we work closely with participants and their families to make the most of each funding category, ensuring every plan is tailored, effective, and aligned with personal goals.
This reference maps the NDIS Registration Groups to the relevant NDIS Support Categories and Support Types (how funding is organised in participant plans). Use it for service mapping, billing, and website clarity.
This table provides a complete reference mapping of all NDIS registration groups to their corresponding support categories, audit pathways, and required Practice Standards modules. It also includes the official module numbers (1–5) for easy cross-reference with the NDIS Quality and Safeguards Commission framework. The interactive filters and sticky header allow users to quickly sort, search, and identify the compliance requirements applicable to each service type—making it a practical tool for governance, quality audits, and provider registration planning.
NDIS Pricing Arrangements and Price Limits assist participants and disability support providers in understanding how price controls for supports and services work in the NDIS.
https://carendis.au/ndis-price-explorer/
We acknowledge Aboriginal and Torres Strait Islander people as the Traditional Custodians of the land and acknowledge and pay respect to their Elders, past and present