Form · Personal Injury & Compensation

WorkSafe Form D, authority to release medical information: completion guide

Link to WorkSafe Form D, the signed authority and consent to release medical information that accompanies a common law damages application.

Kind: Form. A form to complete, or a guide to completing an official one.
Where it applies: Victoria
AI use: Yellow You and the tool draft together, with you directing. You check every statement you rely on.
Law stated as at: 23 October 2026
Status: Maintained. Checked on 23 October 2026 against the official form at worksafe.vic.gov.au and the 2 authorities it cites, for Victoria.
Version: 1
Source: Link to the official form. Licence: © State of Victoria. Link only: download the current form from the official page each time; do not copy or adapt it.

Where this comes from

The official form is published by worksafe.vic.gov.au; this page is a completion guide. Last checked on 2026-10-23.

When to use it

Use when a worker must sign Form D so a common law damages application can be assessed. The worker signs the current PDF. It is sent with Form A.

Used for these tasks

Each task page says how far AI may help with the task and what the lawyer must review.

How AI may be used

The tool may list the treating practitioners already on the file so the lawyer can check the signed authority will reach them; the worker signs Form D and the tool writes nothing in it.

AI may

List treating practitioners already on the file, with name and specialty
Note whether a signed Form D is already on the file with the Form A bundle

AI must not

Must not complete or sign Form D
Must not write any declaration or consent on the PDF. The PDF body was not opened
Must not send the signed authority to a treating practitioner, an insurer, or any other person

The lawyer checks

The current PDF is the 3-page form published on 29 October 2024, or a later file if WorkSafe has replaced it
The page describes it as WorkSafe's authority and consent to release medical information, subject to the Accident Compensation Act 1985 and the Workplace Injury Rehabilitation and Compensation Act 2013
The common law page says Form D allows release of the medical information relevant to the application
The worker signs it, and it is included with Form A
Health information stays in a firm-controlled tool. Check ASCR r 9, APP 11, and whether any disclosure would be a notifiable breach under the Privacy Act 1988 (Cth).

Method: how the Green, Yellow and Red levels are decided. This is guidance for planning, not legal advice.

Authorities

Official form

Open the official form. Always use the current version from the issuer. Licence: © State of Victoria. Link only: download the current form from the official page each time; do not copy or adapt it..

Read the full text

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The summary, the law it rests on and the AI-use guidance above stay public. Privacy.

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