Forms and Referral Templates in *WORD * RTF and *PDF

 

 Instructions for loading and importing MD Templates
 Aged Care
 CDM Items - GP Management Plans and Team Care Arrangements
 45 Year Old Health Checks

 GP Exercise Referral Scheme

 Mental Health Plans

 Shared Antenatal Care

 Lifescripts - smoking cessation, nutrition, alcohol and phsyical activity
 Health Assessment

*PDF* DOCUMENTS

Some of the documents are provided as Adobe Acrobat pdf files. You will need to install the Adobe Acrobat reader on your computer to view them. The Adobe Acrobat Reader is available free of charge from Adobe's website http://www.adobe.com 

*RTF* DOCUMENT TEMPLATES - DOWLOADING AND IMPORTING RTF MEDICAL DIRECTOR (MD) TEMPLATES FROM THE WEBSITE

What to do with the "RTF"link: DO NOT DOUBLE CLICK ON THE *RTF* LINK TO OPEN IT - THIS WOULD OPEN THE TEMPLATE IN WORD. The end result of this is that you would lose the Medical Director fields that "populate" the template.

  1. Right click on link and select Save Target As...

  2. Select a location on hard drive (which you can find later) and save.

  3. Open Medical Director and then LetterWriter.

  4. File menu > Select Modify Template > Select Blank template.

  5. File > Select Import- locate downloaded file and click on Open.

  6. File > Select Save as template - type in appropriate name and click on Save.

  7. Once saved you can access the template with a patient record open in Medical Director. Open LetterWriter - File/New and then select the appropriate template.

Please note most of the "RTF" templates were developed using MD2 version. Importing these "RTF" templates onto MD3 may cause errors in the 'date' fields section of the document ie. MD3 automatically changes the 'date' field properties into 'character'. Therefore, once you have imported the RTF templates onto MD3 please change the 'date' (which have been converted to 'character') field properties to 'date' prior to using them or merging the template with the patient file.

MD Instruction Notes for download

Instruction Notes for RTF MD Templates     PDF (84KB)

  

MENTAL HEALTH TEMPLATES

Mental Health Plan and Review Referral Templates for GPs

Sutherland Mental Health Assessment Template

WORD (54KB)        RTF FOR MD (42KB)
Sutherland Mental Health Plan and Review Template        WORD (48KB)    RTF FOR MD (34KB)

ATAPS Program Templates

Sutherland Mental Health Assessment Template

WORD (54KB) RTF FOR MD (42KB)
Sutherland Mental Health Plan and Review Template        WORD (48KB)       RTF FOR MD (34KB)

Fax coversheet (MH)

WORD (1,969KB)

Fax coversheet (Co-morbidity group)

WORD (1,973KB)
 

AGED CARE TEMPLATES

Comprehensive Medical Assessment (Item 712) 

A CMA form is available in Medical Director however in many of the local RACFs they use a Common Admission form the GP only needs to complete page 4 to claim the CMA item.

Common Admission to RACF form    PDF (51KB ) 
Medical Assessment of CMA (page 4) MD Template           RTF FOR or MD (18.3KB)

   

 

Residential Medication Management Reviews (Item 903)

RMMR GP Referral Form          PDF (36.4KB)     RTF FOR MD (28KB ) 

RMMR Management Template                

PDF (30.4KB) RTF FOR MD (19KB)
  

Contribution to Care Plan (Item 731)

Care Plan Management Template                PDF (30KB)             RTF FOR  MD (19KB)
        

Referral to Allied Health & Dental Services

Allied Health Form       

RTF FOR MD (310KB)  

Dental Care Form          

RTF FOR MD (301KB)

Case Conference (Item 734-738 and 775-779)

Case Conference Management Template      
PDF (32KB)     RTF FOR MD (27KB) 
      

Resident Consent Form for individual EPC Items

Resident Consent Form for individual EPC Items    

PDF (KB)

Explaination of individual EPC MBS items for RACFs

Comprehensive Medical Assessment Items 712                

PDF (KB)

Residential Medication Mangement Review Item 903    

PDF (KB)

Contribution to Care Plan Item 731

PDF (KB)

Allied Health and Dental Care Referrals

PDF (KB)

Organise or participate in RACF Case Conference

PDF (KB)

Transfer of Medical Care – GP to GP for Patients Entering RACFs

Transfer of Medical Care Flowchart    PDF (28KB)
Transfer of Medical Care Form    PDF (38KB)
Transfer of Medical Care MD Template         RTF FOR MD (37KB)

Hospital Interface

RACF Transfer to Hospital Form (Nursing) - this form was developed and piloted by local RACFs, Sutherland Hospital and the Division. Through collaboration with the SESIAHS the form has been further enhanced for use by RACFs and all hospitals in the SESIAHS. It is suggested that RACFs use this form when transferring a patient to hospital. This form is used by all the hospitals in the SESIAHS when discharging a patient to an RACF.

RACF Transfer to Hospital Form - Nursing   PDF (332KB) 
RACF & SESIAHS Aged Care Discharge Summary Form  

 PDF (29KB)

Transfer of Medical Care Form

Transfer of Medical Care Form             PDF (38KB)    RTF FOR MD (37KB)

Southcare Referral Forms

Southcare GP Fax Referral to Non-Medical Service     WORD (94KB)      RTF FOR MD (25KB)
Southcare Referral to Geriatrician WORD (83KB)  RTF FOR MD (8KB)
Southcare Referral to Podiatrist    WORD (79KB) 

CHRONIC DISEASE PREVENTION AND MANAGEMENT TEMPLATES

CDM Items GP Management Plans and Team Care Arrrangements

Preparation of GP Management Plan (721) and Team Care Arrangement (723)     WORD (55KB)     RTF FOR MD (24KB)
Preparation of a GP Management Plan for Diabetic Patients WORD (87KB) RTF FOR MD (24KB)

Review (725 and 727) GP Management Plan and Team Care Arrangement

WORD (50KB) RTF FOR MD (20KB)

Cover Letter Team Care Arrangement to Allied Health Professionals

RTF FOR MD  (6KB)
GP Referral Template to Cardiac Rehab, Diabetes Education Centre,
Dietetics Department, Heart and Lung Team Sutherland Hospital
PDF (32KB) RTF FOR MD (38KB)

45 YEAR OLD HEALTH CHECKS TEMPLATES

45 Year Old Health Check Forms

45 Year Old Health Check Template  WORD (63KB)     RTF FOR MD (35KB)
Patient Recall Letter Generic Template WORD (30KB) RTF FOR MD (9KB)
Patient Recall Letter 'at risk' recall Template     WORD (29KB) RTF FOR MD (7KB)

GP EXERCISE REFERRAL PROGRAM (GPERS) TEMPLATES

GP Exercise Referral Templates for GPs registered to the program 

GPERS Referral Template to the Leisure Centre  PDF (69KB)
GPERS Referral Template to the Leisure Centre MD Template     RTF FOR MD (39KB)
Referral Agreement Process (RAP Form) PDF (55KB)
 

LIFESCRIPTS TEMPLATES (DEVELOPED BY AUSTRALIAN GENERAL PRACTICE NETWORK)

Lifescripts Assessment Tools   PDF (471KB)

Lifescripts Smoking Assessment MD Template     RTF FOR MD (18KB)
Lifescripts Nutrition Assessment MD Template  RTF FOR MD (10KB)
Lifescripts Alcohol Assessment MD Template   RTF FOR MD (167KB)
Lifescripts Physical Activity Assessment MD Template   RTF FOR MD (21KB)
Lifescripts Weight Management Assessment MD Template         RTF FOR MD (15KB)

Lifescripts Prescription Tools   PDF (474KB)

Lifescripts Smoking Prescription MD Template    

RTF FOR MD (64KB)
Lifescripts Nutrition Prescription MD Template  RTF FOR MD (17KB)

Lifescripts Alcohol Prescription MD Template  

RTF FOR MD (182KB)

Lifescripts Physical Activity Prescription MD Template   

RTF FOR MD (28KB)

Lifescripts Weight Management Prescription MD Template        

RTF FOR MD (42KB)

Lifescripts Guidelines    PDF (32KB)

Lifescripts Smoking Guidelines MD Template  

RTF MD (30KB)

Lifescripts Nutrition Guidelines MD Template

RTF MD (27KB)

Lifescripts Alcohol Guidelines  MD Template

RTF MD (29KB)

Lifescripts Physical Activity Guidelines MD Template   

RTF MD (29KB)

Lifescripts Weight Management Guidelines MD Template          

RTF MD (34KB)


WOMENS HEALTH - ANTENATAL SHARED CARE TEMPLATES

Antenatal Shared Care Resources for GPs who are registered with the program

Letter (sample) from GP to ANCP - Patient needs to be assessed for SANC    WORD (26KB)
Letter (sample) from GP to Patient - Missed appointment PDF (86KB)

Antenatal Referral Forms for all GPs

Combined Sutherland and St George Hospitals Antenatal Referral Form         WORD (80KB)    PDF (44KB)
Royal Hospital for Women Antenatal Referral Form WORD (49KB) PDF (46KB)

GENERAL PRACTICE SUPPORT TEMPLATES

Health Assessment Form over 75 yr old  
SDGP Health Assessment Form for over 75 year old    WORD (344KB)

Practice Nurse Network Forms  
SDGP Membership Practice Nurse Network Forms        WORD (59KB)