Templates



Select a category:    

The following templates and forms have been compiled by gpns
the Government and other Divisions around Australia.

Click here for a "how to" guide to importing templates into Medical Director.
Click here for a "how to" guide to importing templates into Best Practice.

Click here for the Medical Director Templates Tips

All Medical Director templates are compatible with Best Practice

*New*

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Adelaide Radiotherapy Centre

Public Referral - [Medical Director] - [Word] - Oct 2008

Aged Care
Go to Aged Care Program Page

Aged Care Access Initiative Referral - [Medical Director] - March 2010
Alzheimers SA Referral - [Medical Director] - April 2009
Dementia Link Worker Referral - [Medical Director] - Jan 2009

Allied Health Services

EPC Allied Health Referral - [Medical Director] - Oct 2008
Referral - [Medical Director] - May 2007
 

Argus

For all Argus templates, please visit the website.

Australian Electoral Commision

Australian Electoral Commission - Medical Certificate (Unsound Mind) - August 2010
Australian Electoral Commission - Objection to Enrolment - August 2010

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Bowel Cancer

National Bowel Cancer Screening Program Referral - [Medical Director] - Oct 2007
 

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Chronic Disease Community Program
Go to CDCP Page
Accredited Provider List - Jan 2010
CDCP Information for GPs
CDCP Referral - [Medical Director] - [Word] - March 2010 

Chronic Disease Management
Go to CDM Program Page

Arthritis GPMP & TCA - [Medical Director] - Oct 2007
Asthma Action Plan - [Medical Director] - Feb 2009
Business Case Spreadsheet - includes May 2010 MBS changes
Chronic Heart Disease (Heart Foundation) - [Medical Director] - (website - page end to download) - June 2009
Chronic Heart Failure GPMP & TCA - [Medical Director] - Oct 2007
COPD Action Plan - [Medical Director] - Oct 2007 (from National Prescribing Service)
COPD GPMP & TCA - [Medical Director] - August 2008
Dementia GPMP and TCA - [Medical Director] - August 2009
Diabetes GPMP & TCA - [Medical Director] - July 2010
Generic GPMP [Medical Director] - Oct 2007
GPMP and TCA - Palliative Care - [Medical Director] - Sept 2009
TCA Cover Letter - [Medical Director] - July 2010
TCA Standard Form - [Medical Director] - July 2010
TCA Standard Review - [Medical Director] - July 2010
 

Chronic Disease Prevention
Go to Prevention Page

Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) - [Medical Director] - [Word] - July 2010
Chronic Disease Risk Program Referral - [Medical Director] - [Word] - May 2010
Do It For Life (DIFL) Referral - [Medical Director] - March 2010

Commonwealth CarelinkSA

Commonwealth Carelink referral - April 2005
Phone 1800 052 222 

Community Health Centre

See Southern Primary Health Referral

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Day Therapy Centres

Common Referral - [Medical Director] - May 2010

Dental Services under Medicare

(MBS Items 85011-87777)
Referral - [Medical Director] - June 2009

DVA

Continence Products Order Form - [Medical Director] - April 2008

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Enuresis

Primary Nocturnal Enuresis Template - [Medical Director] - July 2009 

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Falls Prevention

Southern Community (Pathways to Independence Program) Referral - [Medical Director] - May 2010

Flinders Medical Centre (FMC)

FMC Referral - [Medical Director] - May 2010
       (for Booked Psychiatric Assessment Referral, click here)
Children's Assessment Team Referral - [Medical Director] - March 2007
FMC Outpatient Clinics
Immunology/Allergy Referral Guidelines
Neurosurgery Referral - [Medical Director] - Feb 2010
         (Childrens Assessment Questionnaire [Medical Director], Childrens Assessment Team website)  
Pain Management Unit Referral - [Medical Director] - March 2010
Podiatry referral - click here
Transient Ischemic Attack (TIA) Referral - [Medical Director] - August 2010
     for the TIA Clinical Care Pathway, please download this document

Flinders Private Hospital

Endoscopy Referral - [Medical Director] - March 2010
Rapid Knee Assessment Referral* - [Medical Director] - June 2007
Sleep Referral - [Medical Director] - March 2010
Southern Neurology - [Medical Director] - March 2008
Specialist's Clinic Referral - [Medical Director] - March 2009 

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GP Access South

Referral - [Medical Director] - Jan 2007

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Health Assessment
 

With the exception of the Aboriginal Health Assessments (MBS Item No. 715) all Health Assessments are time based as follows:-

MBS Items - 701 (brief - less than 30 minutes)

                    703 (standard - 30-45 minutes)

                    705 (long - 45-60 minutes)

                    707 (prolonged - more than 60 minutes)

45-49 YO Health Check (Concise) - [Medical Director] - Oct 2007
45-49 YO Health Check - [Medical Director] - Oct 2007 
Aboriginal Adult Health Check - (MBS Item 715) - [Medical Director] - Dec 2006
Aboriginal Child Health Check - (MBS Item 715) - [Medical Director] - Dec 2006
Aboriginal Over 55 Health Assessment (MBS Item 715) - [Medical Director] - August 2008
Comprehensive Medical Assessment for Residents of aged Care Facilities - [Medical Director] - Oct 2007
Intellectual Disability Health Assessment - [Medical Director] - June 2008
Healthy Kid Check - [Medical Director] - August 2008
Over 75s Health Assessment - [Medical Director] - [Medtech] - July 2007
Over 75s Health Assessment - [Medical Director] - (Old Version)
Type 2 Diabetes Risk Evaluation - [Medical Director] - original template from Monash Division of GP - July 2010
Victorian Template of Refugee Health Check - Nov 2007
 

HMR
 

HMR and RMMR Combined Referral [Medical Director] - Oct 2007
HMR Medication Management Plan [Medical Director] - Oct 2007
HMR Referral - [Medical Director] - Oct 2009
 

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Immunisation
Go to Immunisation Program Page

ACIR Letter notifying PHx Varicella - [Medical Director] - August 2007
Gardasil Patient Consent Form - [Medical Director] - Sept 2007 (Compiled by Dr Terry Rose)
Gardasil Patient Invitation [Medical Director] - Gardasil Letter (Word) - July 2007
H1N1 Influenza Vaccination Recall Letter - [Medical Director] - Oct 2009
Immunisation Exemption Conscientious Objection Form [Medical Director] - Feb 2008
Immunisation Exemption Medical Contraindication Form [Medical Director] - Feb 2008

Infectious Disease Notification

Notifiable Disease Form (2008) 

Inner Southern Community Health Service

ISCHS Diabetes Referral - [Medical Director] - May 2008

Lifescripts

There are a range of tools and resources available to support the implementation and use of Lifescripts.  The AGPN website has a valuable resource listing of Lifescripts. Click here to visit their library.

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Meals on Wheels

Referral - [Medical Director] - [Word] - Nov 2008

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Mental Health
Go to Mental Health Programs Page

Booked Psychiatric Assessment Referral - [Medical Director] - [Word] - Feb 2010
DASS Scoring Template - The DASS, DASS21 short version and the scoring template (printable as a transparent overhead sheet for easy scoring).
GP Mental Health Care Plan Review (2712) - [Medical Director] - Oct 2008
K10 Mental Health Assessment - [Medical Director] - Jan 2008
Physical Health Screening template - [Medical Director] - Nov 2008
Services Non-Urgent Referral - [Medical Director] - Feb 2009
Treatment Plan (MBS Item 2710/2702) - [Medical Director] - Dec 2009
Referral Letter - [Medical Director] - Oct 2008
Strengths and Difficulties Questionnaire - online version. An Outcome Measurement Tool, suitable for children, evidence based, easy to score and available free of charge.  

Metro Dom Care

AACAT and Metro Domiciliary Care Referral Form (MD Template) - [Medical Director] - Dec 2006
Metro Domiciliary Care - Referral Form
Phone: 8193 1234 ; Fax: 8193 1201 ; Contact: Leah ; Printed form available by fax.
Website

Metro Home Link

About Metro Home Link
Referral - [Medical Director] - April 2008 

Motor Accident Commission / WorkCover SA

Injury Recovery Care Plan - [Medical Director] - [Best Practice] - [Word] - Oct 2008
Notification of Motor Vehicle Injury - [Medical Director] - [Best Practice] - [Word] - Oct 2008

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Noarlunga Hospital

Noarlunga Health Services Referral - [Medical Director] - Feb 2009
Noarlunga Hospital Allied Health Outpatient Services Referral - [Medical Director] - Nov 2009
Noarlunga Hospital Cardiac Clinic Referral - [Medical Director] - June 2009
 

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Palliative Care
Go to Palliative Care Page

Needs Assessment Tool - Progressive Disease - [Medical Director 3 ONLY]*
Needs Assessment Tool - Progressive Disease Cancer - [Medical Director 3 ONLY]
 

*Templates developed by the Centre for Health Research and Psycho-Oncology and Cancer Council NSW, for more information, read Palliative Care Needs Assessment Guidelines & Needs Assessment Tool

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Podiatry - Southern Region

SAHS Podiatry Referral - [Medical Director] - [Word] - For referrals to FMC, RGH, Noarlunga Hospital and Southern Primary Health - Inner South - June 2009

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Quit SA

Referral - [Medical Director] - Jan 2008

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Refugees
Go to Refugees Page
RDNS

Medication Authorisation [Medical Director] - Oct 2009
RDNS Insulin Commencement Program - Medication Authority - April 2008 (Word)
Referral [Medical Director] - Nov 2007
Phone: 1300 363 262 ; Fax: 8378 5383 (Web support)

Repatriation General Hospital

Adelaide Institute of Sleep Health referral
Hip and Knee Clinic Referral - [Medical Director] - Oct 2009
Hip and Knee Clinic Referral and Management Guidelines
Outpatient Waiting Times - August 2010
Referral [Medical Director] - Feb 2010
VAGAS referral [Medical Director] - to Dr Craig Whitehead at the Southern Fleurieu Health Service

Royal Adelaide Hospital (RAH)

Outpatient Referral - [Medical Director] - Feb 2008
Referral Forms for GPs

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SA Heart Centres

Referral - [Medical Director] - August 2009

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Southern Adelaide Palliative Services

Phone: 8275 1732 ; Fax: 8277 4957 - Printed form available by fax.
Referral - [Medical Director] - Sept 2008
Website

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Southern Primary Health (Community Health Centre)

Common Referral - [Medical Director] - [Word] - April 2009
Southern Primary Health Common Referral Information
Southern Primary Health Common Referral Response
Southern Primary Health GP Referral Protocols 

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