Forms and Templates
Click to download forms and templates:
Aged Care
Alcohol Audit Tool
Allied Health
Allied Health North Burnett
Asthma
ATSI Health Checks
Better Access to Mental Health Care
Better Outcomes in Mental Health Care
Breast Cancer
BreastScreen Queensland
Bush Children's Health Scheme
Child Health
Child Protection
Chronic Disease Management:
Cardiac Rehabilitation Phase II
Cardiovascular Disease (CVD)
Chronic Kidney Disease (CKD)
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Heart Disease (CHD)
Diabetes Education and Management
Closing the Gap
Dental services
Department of Transport
Diabetes: Lifestyle Modification Program
Family Connect
Healthy Kids Health Check
Home Sleep Study
Hospitals:
Queensland Health generic: EDS address book form
45 - 49 year old health check
Lighten Up program
Paediatric assessment tools
Palliative Care
Patient Travel Subsidy Scheme
Queensland Civil and Administrative Tribunal (QCAT): Report by medical and related health professionals – Guardianship and Administration Act 2000
Queensland Courts Forms: Coroners Act 2003, Cremations Act 2003
Rural Primary Health Services (RPHS)
Workers' Compensation
Aged Care
Checklist (PDF 75 KB)
EPC program referral form for Allied Health Services under Medicare (PDF)
EPC program referral form for Allied Health Services under Medicare (RTF)
Service Description Flowchart (PDF 28 KB)
Comprehensive Medical Assessment (CMA) form (PDF)
Comprehensive Medical Assessment (CMA) form (RTF)
Alcohol Audit Tool
Click here to download Alcohol Audit Tool (PDF)
Allied Health
Fax back sheet (RTF)
Allied Health North Burnett
Referral to Rural Allied Health and Community Health Services North Burnett only
Rural Chronic Disease Support Service North Burnett Information Brochure
Click here to view Service Directories
Asthma
Asthma Action Plans produced by NACA
Asthma Cycle of Care
ATSI Health Checks
MBS item 715: ATSI child health check (RTF)
MBS item 701: ATSI 15-55, 55+ health check (RTF)
General Practice North has a comprehensive range of clinical templates for Aboriginal Health Assessments that can be downloaded in Medical Director
Better Access to Mental Health Care
New templates will be provided soon.
Click here to visit the Better Access to Mental Health Care Program page
Better Outcomes in Mental Health Care (BOiMHC)
BOiMHC referral form (PDF)
Click here to visit the BOiMHC Program page for Medical Director and Best Practice templates
Breast cancer
Breast cancer management plan (PDF)
McGrath Breast Care Nurse referral form (PDF)
BreastScreen Queensland
New BreastScreen Queensland GP electronic recommendation forms are now available for Best Practice, Medical Director, Genie and Practix software programs.
Visit BreastScreen Queensland to download forms
Bush Children's Health Scheme
Referral form
MBS item 721 generic template (RTF)
MBS item 723 generic template (RTF)
Patient Consent form
EPC program referral form for Allied Health Services under Medicare (RTF)
EPC RN request & consent form
Click here to visit the CDM Program page
Cardiovascular Disease (CVD)
MBS item 721 template (RTF)
MBS item 723 template (RTF)
Click here for GP Management Plan and other resources for Coronary Heart Disease developed by Heart Foundation
Click here to visit the CVD Program page
Child Health
Ellen Barron Family Centre referral form
Child Protection
Non Q health reporting template (PDF)
Click here to visit Child Protection page for further information
Chronic Kidney Disease (CKD)
MBS item 721 template (RTF)
MBS item 723 template (RTF)
Click here to visit the CKD Program page
Chronic Obstructive Pulmonary Disease (COPD)
Bundaberg Hospital COPD referral form (PDF)
Hervey Bay Hospital COPD referral form (RTF)
Maryborough Hospital COPD referral form (RTF)
MBS item 721 template (asthma) (RTF)
MBS item 723 template (asthma) (RTF)
Click here to visit the COPD Program page
Closing the Gap
Client transport referral form
Care coordination and supplementary services (CCSS) referral form
Medicare forms and guidelines
Click here to visit Closing the Gap program page for other forms and fact sheets
Coronary Heart Disease
GP management plan
Dental Care
Referral form for dental services under Medicare
Department of Transport
Disability parking permit scheme application form
Medical certificate for motor vehicle driver
Taxi subsidy scheme application form
Diabetes Education and Management
Type 2 diabetes risk evaluation for MBS items 701 to 707, 715
The Australian type 2 diabetes risk test
MBS item 721 (RTF)
MBS item 723 (RTF)
EPC referral form (individual) (RTF)
EPC referral form (group) (RTF)
EPC referral form (group) for Best Practice/MD
Click here to visit the Diabetes Education & Management Program page
Diabetes: Lifestyle Modification Program (LMP)
MBS items 701 to 707 (RTF)
MBS item 715
Diabetes Type 2: DoHA GP Referral Form for Lifestyle Modification program
Click here to visit the LMP program page
Family Connect
Referral form
Healthy Kids Health Check
MBS items 709 & 711 template (RTF)
Healthy kids health check information sheet
Home Sleep Study
Referral form
45 - 49 year old health check
45 year old health check MBS Item 717 template (RTF)
45 year old health check DoHA fact sheet
45 year old health check DoHA questions & answers
45 year old health check RACGP checklist
45 year old health check DoHA proforma
Lighten Up
Referral form for Lighten Up program (PDF)
Referral form for Lighten Up program (word)
Vanderbilt assessment scale
Community Child Health: Click here for developmental milestone charts by age
Palliative Care
Needs assessment tool: Progressive disease cancer (RTF for Best Practice)
Needs assessment tool: Progressive disease generic (RTF for Best Practice)
Palliative Care Needs Assessment Guidelines (summary)
Palliative Access referral form
Patient Travel Subsidy Scheme
Click here for information and Forms A and B
Click here for PTSS guidelines
Queensland Courts forms
Coroners Act 2003
Cremations Act 2003
Reportable deaths flowchart
Rural Primary Health Services (RPHS)
RPHS Interactive referral form (PDF)
RPHS referral form (RTF)
Click here to visit the RPHS program page
WORKERS' COMPENSATION
www.workcoverqld.com.au
www.qcomp.com.au
Workers' compensation medical certificate
Some of the above documents require the use of the Adobe Reader, free software available from adobe.com
- Townsville General Practice Network has developed a very useful site for forms and templates
