---
title: "WorkSafe Form D, authority to release medical information: completion guide"
url: "https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-form-d"
type: "precedent"
site: "AI Law Framework"
id: "a21-form-vic-worksafe-form-d"
area_id: "A21"
kind: "form"
ai_level: "yellow"
version: 1
task_ids: ["A21-T1-R5", "A21-T1-R8", "A21-P20260916-1"]
law_stated_as_at: "2026-10-23"
---

# 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.

Canonical page: https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-form-d  
Law stated as at: 2026-10-23

Site index for agents: https://ailawframework.com/llms.txt

## Key facts

- Kind: Form. A form to complete, or a guide to completing an official one.
- Practice area: [Personal Injury & Compensation](https://ailawframework.com/precedents/personal-injury-and-compensation.md)
- Jurisdictions: Victoria
- AI level: Yellow. You and the tool draft together, with you directing. You check every statement you rely on.
- Law stated as at: 2026-10-23
- Status: Maintained. Checked on 2026-10-23 against the official form at worksafe.vic.gov.au and the 2 authorities it cites, for Victoria.

## 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

- [Draft the pre-action notice or statutory claim form from the instructions](https://ailawframework.com/practice/personal-injury-and-compensation/draft-the-pre-action-notice-or-statutory-claim-form-from-the-instruction.md)
- [Draft medico-legal instructions and review the draft report](https://ailawframework.com/practice/personal-injury-and-compensation/draft-medico-legal-instructions-and-review-the-draft-report.md)
- [Find gaps and duplicates in a medical-record set](https://ailawframework.com/practice/personal-injury-and-compensation/find-gaps-and-duplicates-in-a-medical-record-set.md)

## 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).

## Authorities

- [WorkSafe Victoria, Form D, published 29 October 2024 (opened 23 October 2026)](https://www.worksafe.vic.gov.au/resources/authority-and-consent-release-medical-information-form-d)
- [WorkSafe Victoria, Common law claim for damages (opened 23 October 2026)](https://www.worksafe.vic.gov.au/common-law-claim-damages)

## Official form

[Official form](https://www.worksafe.vic.gov.au/resources/authority-and-consent-release-medical-information-form-d)

## 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.

## Full text and drafting notes

The full text and the drafting notes are not part of this public page. Signed-in firm accounts can read them at https://ailawframework.com/precedents/personal-injury-and-compensation/form-vic-worksafe-form-d and through the signed-in MCP connector https://ailawframework.com/mcp/firm.

*Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*