Clinical Software Templates

Downloading Templates
Importing Template Instructions
eReferral Templates
Chronic Disease Management
Aged Care
Palliative Care
Aboriginal Health
Home Medication Review
Health Assessments
Allied Health EPC Items
Health Checks
Mental Health
Breastscreen NSW
Diabetes Management
Ambulance Authorised Care Plans
MPHN Specific
Community Paediatric GP Support
MyMedicare
Contact

Downloading templates:

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

2. Select a location on your hard drive (such as the Desktop or My Documents) and select Save.

Note: Do not open in Word if you intend to import into a clinical software

Importing Template Instructions

• Medical Director

• Best Practice

eReferral Templates

• Medical Director Installation Files (.zip)

• Best Practice Installation Files (.zip)

• Medical Director - Argus User Guide (.pdf)

• Medical Director - Healthlink User Guide (.pdf)

Chronic Disease Management

• GPMP - Generic (Item 721) (.rtf)

• GPMP - Asthma (Item 721) (.rtf) GPMP - Asthma with Reviews(.rtf) Includes columns for reviews (landscape)

• GPMP - CHD (Item 721) (.rtf)

• GPMP - CHD (.rtf) (MD3) Developed by the Heart Foundation

• GPMP - Childhood Disability (Item 721) (.rtf)

• GPMP - Depression/Anxiety (Item 721) (.rtf)

• GPMP - Diabetes (Item 721) (.rtf)

• GPMP - Kidney Disease for BP (Item 721) (.rtf)

• GPMP - Kidney Disease for MD (Item 721) (.rtf)

• GPMP - Osteoarthritis (Item 721) (.rtf)

• GPMP - Osteoporosis (Item 721) (.rtf)

• GPMP - Palliative Care (Item 721) (.rtf)

• GPMP Review (Item 732) (.rtf)

• TCA - Generic (Item 723) (.rtf)

• TCA - Asthma (Item 723) (.rtf)

• TCA - CHD (Item 723) (.rtf)

• TCA - Depression/Anxiety (Item 723) (.rtf)

• TCA - Diabetes (Item 723) (.rtf)

• TCA - Osteoarthritis (Item 723) (.rtf)

• TCA - Osteoporosis (Item 723) (.rtf)

• TCA Review (Item 732) (.rtf)

• GPMP/TCA Generic (Items 721 & 723) (.rtf) - October 2010

• GPMP/TCA - Hypertension (Items 721 & 723) (.rtf) - October 2010

• GPMP/TCA - COPD (.rtf)

• Care Plan for CVCP Participants (.rtf)

• Fax Sheet to Team Care Arrangement Members (.rtf)

• Team Care Arrangement Refusal Letter (.rtf) - Aug 2008 - a letter to health professionals explaining the correct procedure for initiation of TCA's

• Letter to AHPs regarding ineligable patients (.rtf) - November 2009

• Letter to AHPs regarding patients with existing care plans(.rtf) - November 2009

• COPD Action Plan (.rtf) - October 2010

• Get Healthy Referral Form - 'Get Healthy' Information and Coaching service - December 2009

• Asthma Foundation Referral Service - link to Asthma Foundation website

Aged Care

• Comprehensive Medical Assessment (.rtf) - NEVDGP version - now includes time based item numbers - June 2010

• NAT:PD-C (.rtf) - Needs Assessment Tool: Progressive Disease - Cancer - June 2010

• CHIME Referral Form (.doc) - a paper-based version

• CHIME Referral Form (.rtf) - template version - Oct 2012

• Advanced Care Plan for person capable - June 2013 (.pdf)

• Advanced Care Plan for person incapable - June 2013 (.pdf)

• ACAT Intake Form (.doc) - a paper-based version

• ACAT Intake Form (.rtf) - template version - Oct 2012

Palliative Care

• NAT:PD-C (.rtf) - Needs Assessment Tool: Progressive Disease - Cancer - June 2010

• GPMP - Palliative Care (Item 721) (.rtf)

• MLHD CCIS Referral Form for BP (.rtf)

Aboriginal Health

• ATSI Practice Incentive Program Patient Registration (.rtf) - July 2010

• ATSI Practice Incentive Program Patient Consent (.rtf) - July 2010

• ATSI Practice Incentive Program Patient Withdrawal (.rtf) - July 2010

• ATSI Patient Letter (.rtf) - February 2011 - A letter practices can use to send to ATSI patients explaining the Indigenous PIP and PBS Co-Payment measure and introducing the services of RDGPs Aboriginal Outreach Worker

• Child Health Check Screen (.pdf) - DoHA template - March 2011

• 15-54 Adult Health Check Screen (.pdf) - DoHA template - March 2011

• 55+ Health Check Screen (.pdf) - DoHA template - March 2011

Home Medication Review

• DMMR Plan - BP (.rtf)

• DMMR Plan - MD (.rtf)

• DMMR Referral - BP (.rtf)

• DMMR Referral - MD (.rtf)

• DMMR Referral with Patient Information Sheet (.rtf) - October 2009 - includes a sheet at the end of the template that can be given to the patient explaining the process and cost of a Home Medicines Review.

Health Assessments

• Health Assessment (.rtf) - (75+, ATSI 0-4, ATSI 15-55, ATSI 55+) - now includes time based item numbers - June 2010

• Health Assessment for the Intellectually Disabled (Item 718) (.rtf) - now includes time based item numbers - June 2010

• Refugee Health Assessment (.rtf) - now includes time based item numbers

Allied Health EPC Items

• Allied Health EPC Referral Form (.rtf)

• Allied Health Group Services Referral Form (.rtf)

• Allied Health Group Services / Australian Diabetes Council - Combined Referral Form (.rtf) - October 2009

 Health Checks

• 45-49 Health Check (.rtf) - now includes time based item numbers - June 2010

• 45-49 'At risk' Recall Letter (.rtf) - a letter that can be sent to patients identified as having a risk factor of developing a chronic disease

• 45-49 'May have a risk factor' Recall Letter (.rtf) - a letter that can be sent to patients within the age range and may have one of the risk factors of developing a chronic disease

• 45-49 Reminder Letter for 49yr old patients (.rtf) - a letter to 49yr old patients reminding them of the health check before they turn 50 and are no longer eligable

• Healthy Kids Check (.rtf) no logo

• Healthy Kids Check (.rtf)

• Healthy Kids Check Recall Letter (.rtf) - letter that can be sent to parents/carers of the 4yr old

• Oral Health GP Referral (.pdf) - NSW Early Childhood Oral Health Referral Form - June 2010

Mental Health

• Murrumbidgee Mental Health Drug and Alcohol Alliance Referral Form

• GP Mental Health Treatment Plan - Item 2715 (.rtf)

• K10 (.rtf)

• HONOS Score Sheet (.rtf)

• MPHN Child Treatment Plan (.rtf) - Item 44

Mental Health Treatment Plan

• GPMHSC ATSI Referral Letter Template May 2023 (.rtf)

• GPMHSC ATSI SEWB Plan Template May 2023 (.rtf)

• GPMHSC ATSI SEWB Review Template May 2023 (.rtf)

• GPMHSC Minimal Requirements MHTP Review Template May 2023 (.rtf)

• GPMHSC Minimal Requirements MHTP Template May 2023 (.rtf)

• GPMHSC Request For Services Template May 2023 (.rtf)

• Patient wellbeing assessment and recovery plan (.rtf)

• Patient wellbeing assessment and recovery plan - Adults (.rtf)

• Patient wellbeing assessment and recovery plan - Children and adolescents (.rtf)

Breastscreen NSW

• Referral Form - BP (.rtf)

• Referral Form - MD (.rtf)

Diabetes Management

• NDSS Referral Form (.rtf) - MPHN version - October 2009

Ambulance Authorised Care Plans  

• Adult Palliative Care Plan - BP (.rtf)

• Adult Palliative Care Plan - MD (.rtf)

• Authorised Care Plan - BP (.rtf)

• Authorised Care Plan - MD (.rtf)

• Paediatric Palliative Care Plan - BP (.rtf)

• Paediatric Palliative Care Plan - MD (.rtf)

MPHN Specific

• RDS Colonoscopy and/or Gastroscopy Direct Access Referral Form (.rtf) - Riverina Day Surgery - October 2019

• Mr Henry Hicks Colorectal and General Surgeon Direct Access Referral (.rtf) November 2019

• Wagga Base Hospital Pulmonary Rehabilitation Referral Form (.rtf) - October 2009

• Active Physiotherapy Referral Form (.rtf) - October 2009

• More Allied Health Services Asthma Referral Form (.rtf)

• More Allied Health Services Referral Form (.rtf)

• Wagga Base EEG Request / Report (.rtf) - October 2010

• MLHD GP Referral Form (for MD) (.rtf)

• MLHD GP Referral Form (for BP) (.rtf)

• MPHN CCSS GP Referral Form (.rtf)

• MPHN Parkinson's Support Nurse (.rtf) - September 2014

• Integrated Chronic Disease Program Referral Form (.rtf)

• Pain Management Adult Referral Questionaire (.pdf)

• Pain Management Provider Survey (.docx)

• Vitality Passport Referral Form (.docx)

• Vitality Passport Follow Up Assesment Form (.docx)

• Vitality Passport Information Sheet - Clinicians (.pdf)

• Vitality Passport Information Sheet - Patients (.pdf)

• MLHD CCIS Referral Form (.rtf)

• MLHD CCIS Referral Form (.docx)

• Griffith Aboriginal Medical Service - Drug & Alcohol Program - Client Referral (.rtf)

• Marathon Health - ICC/ITC Referral Form - BP (.rtf)

• Marathon Health - ICC/ITC Referral Form - MD (.rtf)

• WARATAH Referral Form - BP (.rtf)

• WARATAH Referral Form - MD (.rtf)

• MLHD Specialist Menopause Service Referral Form (.rtf)

MyMedicare

• MyMedicare Patient Registration Form for Medical Director (.rtf)

• MyMedicare Patient Registration Form for Best Practice (.rtf)

COVID-19

• Referral form COVID Social Care Navigator for Medical Director

• Referral form COVID Social Care Navigator for Best Practice

CONTACT

Andrew Heap

Senior Manager, Primary Care Engagement
andrew.heap@mphn.org.au
02 6923 3131

Vimal Pasupathy

Digital Health Officer
vimal.pasupathy@mphn.org.au
0448 915 503