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The Queensland Government is in a caretaker period until after the state election. Minimal updates will be made to this site until after the election results are declared.

Repatriation Request (Form E)

Repatriation Request (Form E)

Repatriation Request (Form E)

Section A - Patient details

(patient, HHS or specialist to complete)

Date of birth * (DD / MM / YY)
Date of death * (DD / MM / YY)
(Hospital / Facility name)
Does the deceased identify as being of Aboriginal or Torres Strait Islander descent?
Patient escort details
Date of birth * (DD / MM / YY)
Section B - Evidence

Please attach evidence to facilitate transport

Please attach evidence to facilitate transport
Section C - Return travel for Escort

(if travel not booked, specialist or treating HHS to complete)

Date ready to travel home * (DD / MM / YY)
Travel home time
Recommended return mode of travel:
Section D - Approving hospital details

(Home HHS)

Section E - Escort declaration

(Patient escort to complete)

The information provided is true and accurate at the time of application. I give my permission for Hospital and Health Service staff to obtain information about the deceased patient for the purpose of administering my application. I understand that the family of the deceased patient is responsible for making the transport arrangements with the Funeral Director in consultation with Hospital and Health Service staff. I understand that repatriation is for transportation costs and excludes costs associated with the funeral service.

Date * (DD / MM / YY)
Hospital and Health Service use only

I, as the medical superintendent (or representative), authorise the above transport as required.

Date * (DD / MM / YY)