Templates
Select a category:
*New*
Adelaide Radiotherapy Centre
Aged Care
Allied Health Services
Argus
Australian Electoral Commission
Bowel Cancer
Chronic Disease Community Program
Chronic Disease Management
Chronic Disease Prevention
Commonwealth CarelinkSA
Community Health Centre
Day Therapy Centres
Dental Services under Medicare
DVA
Enuresis
Falls Prevention
Flinders Medical Centre (FMC)
Flinders Private Hospital
GP Access South
Health Assessment
HMR
Immunisation
Infectious Disease Notification
Inner Southern Community Health Service
Lifescripts
Meals on Wheels
Mental Health
Metro Dom Care
Metro Home Link
Motor Accident Commission / WorkCover SA
Noarlunga Hospital
Palliative Care
Podiatry - Southern Region
Quit SA
Refugees
Repatriation General Hospital
RDNS
Royal Adelaide Hospital (RAH)
SA Heart Centres
Southern Adelaide Palliative Services
Southern Primary Health (Community Health Centre)
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 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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National Bowel Cancer Screening Program Referral - [Medical Director ] - Oct 2007
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Accredited Provider List - Jan 2010
CDCP Information for GPs
CDCP Referral - [
Medical Director ] - [
Word ] - March 2010
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
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
D ental 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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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 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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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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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
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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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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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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