Needs assessment and service coordination forms
This is the standard national form for Needs Assessment Service Coordination agencies to record eligibility and service coordination information.
Pātiki and Waharua Kōpito patterns
NASC 1004 Notification
The form should be completed and submitted to the Sector Operations Group to allow payment for services delivered by health care providers.
To access the form you will need to save it to your computer first and open it using Adobe Acrobat Reader.
Contact Sector Operations
Call the Sector Operations Contact Centre to find out more:
0800 855 066 – option 2 – Claims
Mon, Tue, Thu, Fri: 8am – 5pm
Wed: 9.30am – 5pm