Templates and forms
Find referral templates for practice software below.
Ensure you follow instructions on how to open the templates.
For immunisation catch up templates please visit the Immunisation program for health practitioners page.
Statewide and National Forms and Templates
- Allied Health
- COACH Program
- The COACH Program [RFT]
- DASS21
- My Aged Care
- My Health For Life
- Referral form [RTF] – V2.0
- PEN CS Recipes
- National Bowel Cancer Screening
- GP Assessment Report [RTF]
- Veterans Affairs
- D904 Veterans’ Affairs Request/Referral Form – last updated 21/10/2020
- Allied Health
- COACH Program
- The Coach Program [RTF]
- DASS21
- DASS21 Referral Form [RTF]
- DASS21 Scoring [RTF]
- My Aged Care
- My Health For Life
- Referral form [RTF] – V2.0
- PEN CS Recipes
- My Health For Life
- Referral form [RTF] – V2.0
- PEN CS Recipes
- My Aged Care
- My Health For Life
- Referral form [RTF] – V2.0
- PEN CS Recipes
- Allied Health
- Children’s Health Queensland
- Access templates – Last updated 12/05/2020
- COACH program
- The COACH Program [PDF]
- DASS21
- Drug Arm
- Drug Arm referral from [DOC]
- Metro North Hospital and Health Service
- My Aged Care
- My Aged Care [online form]
- My Health For Life
- GP Referral Form [PDF] – Last updated 17/10/2018
- PEN CS Recipes
- National Bowel Cancer Screening
- National Disability Insurance Scheme
- Paediatric Statewide Referral Criteria
- Patient Travel Subsidy Scheme(PTSS)
- PTSS Website – forms and user guides
- Form A: Patient registration form [PDF]
- Form B: Travel referral form [PDF]
- Form C: Appointment attendance form [PDF]
- Form D: Accommodation Confirmation form [PDF]
- Queensland Collaborative Virtual Integrated Pain Service
- Referral form [PDF] – Last updated 16/12/2020
- Queensland Pelvic Mesh Service
- The Queensland Pelvic Mesh Service offers comprehensive assessment and treatment for women with complications from pelvic mesh. Access to resources and referral forms is via the QPMS website.
- Secure Web Transfer and eHealth:
- STS AddressBook Individual Update Form [PDF] This document is used for General Practitioners to update their information within the Queensland Health – STS (Secure Transfer Services) AddressBook for registration to the Health Provider Portal (HPP).
- STS AddressBook Update Form [PDF] This document is used for General Practices to update their information within the Queensland Health – STS (Secure Transfer Services) AddressBook for the delivery of Discharge Summaries and Clinical Letters.
- Statewide Cardiac Rehabilitation
- Statewide Renal Access Surgery
- Dialysis Access Referral [PDF]
Central Queensland
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC referral Yoonthalla Services (Woorabinda) [RTF] – Last updated 07/09/2020
- ITC Referral form Bidgerii [RTF] – Last updated 07/09/2020
- ITC Referral form Nhulundu (Gladstone and Banana) [RTF] – Last updated 07/09/2020
- Allied Health
- LiveBetter Referral Form [RTF]
- LiveBetter Referral Form [PDF]
- Alcohol and other drugs
- Lives Lived Well [RTF]
- Central Queensland Hospital and Health Service
- Alcohol and Other Drugs (AODS) [PDF]
- Breast Screen [RTF]
- Child and Youth Mental Heath [PDF]
- Clinical Measurements [RTF] – Last updated 19/01/2021
- Endoscopy [RTF]
- Maternity Booking In [RTF]
- Podiatry [RTF]
- Specialist Outpatient Department (SOPD)
- Sub Acute Care and Chronic Rehabilitation (SACCR) [RTF]
- Investigations
- Lung Screen Australia X-ray Referral Form [RTF]
- Heart of Australia [RTF]
- Heart of Australia [PDF]
- Mental Health
- Anglicare Central Queensland Referral [WORD]
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [RTF] – Last updated 27/08/2020
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC Referral form Yoonthalla [RTF] – Last updated 07/09/2020
- ITC Referral form Bidgerii [RTF] – Last updated 07/09/2020
- ITC Referral form Nhulundu (Gladstone and Banana) [RTF] – Last updated 07/09/2020
- Alcohol and Other Drugs
- Lives Lived Well [RTF]
- Central Queensland Hospital and Health Service
- Alcohol and Other Drugs [PDF]
- Breast Screen [RTF]
- Clinical Measurements [RTF] – Last updated 19/01/2021
- Child and Youth Mental Heath [PDF]
- Endoscopy [RTF]
- Maternity Booking In Form [RTF]
- Podiatry [RTF]
- Specialist Outpatient Departments eReferral template
- SOPD referral form CQ wide [RTF] – Last updated 01/04/2020
- SOPD referral form Emerald [RTF] – Last updated 01/04/2020
- SOPD referral form Gladstone [RTF] – Last updated 01/04/2020
- Sub Acute Care and Chronic Rehabilitation (SACCR) [RTF]
- Colonoscopy/Gastroenterology
- CQHHS Endoscopy referral form [RTF] – Last updated 01/04/2020
- Investigations
- Lung Screen Australia X-ray referral [RTF]
- Heart of Australia [RTF]
- Heart of Australia [PDF]
- Mental Health
- Anglicare Central Queensland Referral [WORD]
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [RTF] – Last updated 27/08/2020
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC Referral form Nhulundu (Gladstone and Banana) [PDF] – Last updated 15/01/2019
- ITC Referral form Nhulundu (Gladstone and Banana) [Word] – Last updated 25/03/2020
- ITC Referral form Yoonthalla (Woorabinda) [WORD] – Last updated 16/06/2020
- ITC Referral form Bidgerii [PDF] – Last updated 09/072019
- ITC Referral form Bidgerii [Word] – Last updated 05/12/2019
- Allied Health
- LiveBetter Referral [PDF]
- Central Queensland Hospital and Health Service
- Alcohol and Other Drugs (AODS) [PDF]
- Breast Screen [PDF]
- Child and Youth Mental Heath [PDF]
- Clinical Measurements Gladstone
- Endoscopy
- Rockhampton Referral [PDF]
- Pre-Procedure Screening Tool [PDF]
- Hospital in the Home [PDF]
- Maternity Booking In [PDF]
- Nurse Navigator Service [PDF]
- Sub Acute Care and Chronic Rehabilitation (SACCR) Clinic Referral Form [PDF]
- Investigations
- Lung Screen Australia
- X-ray Referral [PDF]
- Mental Health
- Anglicare Central Queensland Referral [WORD]
- Stepped care mental health services
- PHN Mental Heatlh Intake – community referral form [PDF] – Last updated 18/03/2020
- PHN Mental Health Intake – GP referral form [word] – Last updated 20/11/2020
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
Wide Bay
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC Referral for Bundaberg [RTF] – Last updated 09/07/2019
- ITC Referral for Fraser Coast [RTF] – Last updated 31/07/2018
- ITC Referral for North Burnett [RTF] – Last updated 31/07/2018
- Colonoscopy/Gastroenterology
- Colonoscopy/Endoscopy Referral Form [RTF] – Last updated 02/12/2020
- Hepatitis C Treatment MDT
- SCHHS Hep C Referral [RTF] – Last updated 10/07/2017
- Hospital and Health Service Specialist Outpatient Departments eReferral template
- WBHHS eReferral [RTF] – Last updated 08/12/2020
- Pulmonary Rehabilitation
- Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [RTF] – Last updated 12/10/2018
- Rural Primary Health Services
- RPHS Referral Template [RTF] – Last updated 8/11/2018
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [RTF] – Last updated 27/08/2020
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- IWC Indigenous Stepped Care – Bundaberg [RTF] – Last updated 29/10/2020
- Vaccination History or Catchup
- WBHSS Referral Template [RTF] – Last updated 17/10/2018
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC Referral for Bundaberg [RTF] – Last updated 04/07/2019
- ITC Referral for Fraser Coast [RTF] – Last updated 11/07/2018
- ITC Referral for North Burnett [RTF] – Last updated 31/07/2018
- Colonoscopy/Gastroenterology
- Colonoscopy/Endoscopy Referral Form [RTF] – Last updated 02/12/2020
- Hepatitis C Treatment MDT
- SCHHS Hep C Referral [RTF] – Last updated 29 January 2019
- Hospital and Health Service Specialist Outpatient Departments eReferral template
- WBHHS eReferral [RTF] – Last updated 08/12/2020
- Pulmonary Rehabilitation
- Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [RTF] – Last updated 12/10/2018
- Rural Primary Health Services
- RPHS Referral Template [RTF] – Last updated 8/11/2018
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [RTF] – Last updated 27/08/2020
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- IWC Indigenous Stepped Care Mental Health Referral Form – Bundaberg [RTF] – Last updated 29/10/2020
- Vaccination History or Catchup
- WBHSS Referral Template [RTF] – Last updated 17/10/2018
- Hepatitis C Treatment MDT
- SCHHS Hepatitis eReferral [RTF] – Last updated 30 January 2019
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- Therapeutic Referral
- PHN Mental Health Intake – [RTF] – Last updated 22/04/2020
- Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC)
- ITC Referral for Bundaberg [PDF] – Last updated 09/07/2019
- Colonoscopy/Gastroenterology
- Colonoscopy/Endoscopy Referral Form [PDF] – V1 2020
- View on HealthPathways
- Nurse Navigator Service
- WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018
- View on HealthPathways
- Persistent Pain
- Referral form [PDF] – Last updated 09/2014
- Entry patient questionnaire [PDF] – Last updated 20/11/2017
- Rural Chronic Pain Self-Management Group [PDF] – Last updated 18/07/2018
- View on HealthPathways
- Pulmonary Rehabilitation
- View on HealthPathways
- Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [DOCX] – Last updated 12/10/2018
- Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [PDF] – Last updated 12/10/2018
- Ophthalmology
- Ophthalmology referral form [PDF] – V4 2019
- View on HealthPathways
- Rural Allied Health – Community Health
- Rural Allied Health Referral Template [PDF] – Last updated 17/10/2018
- Specialist Palliative Care Rural Telehealth Service (SPaRTa)
- Referral form [PDF] – Last updated 07/2020
- Flyer [PDF]
- Stepped care mental health services
- PHN Mental Heatlh Intake – community referral form [PDF] – Last updated 18/03/2020
- PHN Mental Health Intake – GP referral form [word] – Last updated 20/11/2020
- IWC Indigenous Stepped Care – Bundaberg [PDF] – last updated 29/10/2020
Sunshine Coast
- Nurse Navigator Service
- SCHHS Nurse Navigator Service Referral [RTF] – Last updated 16/12/2020
- Check criteria on HealthPathways
- Pulmonary Rehabilitation
- Pulmonary Rehabilitation Referral Form [RTF] – Last updated 29/01/2019
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- Sunshine Coast Eating Disorders Trial
- Disordered eating screening referral [RTF] – Last updated 20/10/2020
- Sunshine Coast Hospital and Health Service:
- Clinical Investigation Unit
- Nerve Conduction Studies (NCS) referral form [RTF] – Last updated 29/01/2019
- Electroencephalogram (EEG) referral form [RTF] – Last updated 29/01/2019
- Hepatitis C Treatment MDT
- SCHHS Hep C Referral [RTF] – Last updated 29/01/2019
- Open Access Colonoscopy/Gastroscopy
- SCHHS Open Access Endoscopy eReferral v5 [RTF] – Last updated 03/03/2020
- Check criteria on HealthPathways
- Specialist Outpatient Departments eReferral template
- SCHHS eReferral[RTF] – Last updated 29/01/2019
- Gympie eReferral[RTF] – Last updated 07/04/2017
- Fax Cover Sheet [RTF] – Last updated 10/07/2017
- Check criteria on HealthPathways
- Clinical Investigation Unit
- Nurse Navigator Service
- SCHHS Nurse Navigator Service Referral [RTF] – Last updated 16/12/2020
- Check criteria on HealthPathways
- Pulmonary Rehabilitation
- Pulmonary Rehabilitation Referral Form [RTF] – Last updated 29/01/2019
- Stepped care mental health services
- PHN Mental Health Intake [RTF] – Last updated 16/06/2020
- Sunshine Coast Eating Disorders Trial
- Disordered eating screening referral [RTF] – Last updated 20/10/2020
- Sunshine Coast Hospital and Health Service:
- Clinical Investigation Unit
- Nerve Conduction Studies (NCS) referral form [RTF] – Last updated 29/01/2019
- Electroencephalogram (EEG) referral form [RTF] – Last updated 30/01/2018
- Hepatitis C Treatment MDT
- SCHHS Hep C Referral [RTF] – Last updated 29/01/2019
- Open Access Colonoscopy/Gastroscopy
- SCHHS Open Access Endoscopy eReferral v5 [RTF] – Last updated 05/03/2020
- Check criteria on HealthPathways
- Specialist Outpatient Departments eReferral template
- SCHHS eReferral [RTF] – Last updated 29/01/2019
- Gympie eReferral [RTF] – Last updated 7/04/2017
- Fax Cover Sheet [RTF] – Last updated 10/07/2017
- Check criteria on HealthPathways
- Clinical Investigation Unit
- SCHHS Clinical Investigation Unit
- Nerve Conduction Studies (NCS) referral form [RTF] – Last updated 29/01/2019
- Electroencephalogram (EEG) referral form [RTF] – Last updated 29/01/2019
- Stepped care mental health services
- PHN Mental Health Intake– [RTF] – Last updated 16/06/2020
- Sunshine Coast Hospital and Health Service:
- Hepatitis C Treatment MDT
- SCHHS Hepatitis eReferral [RTF] – Last updated 30/01/2019
- Open Access Colonoscopy/Gastroscopy
- SCHHS Open Access Endoscopy Referral [RTF] – Last updated 29/01/2019
- Check criteria on HealthPathways
- Specialist Outpatient Departments eReferral template
- SCHHS eReferral [RTF] – Last updated 29/01/2019
- Check criteria on HealthPathways
- Hepatitis C Treatment MDT
- Pulmonary Rehabilitation
- Pulmonary Rehabilitation Referral Form [PDF] – Last updated 07/05/2019
- Stepped care mental health services
- PHN Mental Heatlh Intake – community referral form [PDF] – Last updated 18/03/2020
- PHN Mental Health Intake – GP referral form [word] – Last updated 20/11/2020
- Nurse Navigator Service
- SCHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018
- Check criteria on HealthPathways
- Persistent Pain
- Referral form [PDF] – Last updated 09/2014
- Entry patient questionnaire [PDF] – Last updated 20/11/2017
- Sunshine Coast Eating Disorder Access Trail (SCEDAT)
- Doctor referral form [WORD] – Last updated 11/11/2020
- Case Consultation Template [WORD] – Last updated 26/11/2020
GP management plan templates
- GP Management Plan [PDF]
- GP Management Plan [RTF – Right click, save as. Medical Director and Best Practice]
- Team Care Arrangements [PDF]
- Team Care Arrangements [RTF – Right click, save as. Medical Director and Best Practice]
- Combined GP Management Plan and Team Care Arrangements [PDF]
- Combined GP Management Plan and Team Care Arrangements [RTF – Right click, save as. Medical Director and Best Practice]
- GP Eating Disorders Plan [RTF]
- GP Mental Health Care Plan Template [doc]
- GP Mental Health Treatment Plan Adults
- Medical Director [RTF] – Last updated 30/11/2020
- Best Practice [RTF] – Last updated 30/11/2020
- Word [doc] – Last updated 30/11/2020
- GP Mental Health Treatment Plan Children
- Medical Director [RFT] – Last updated 30/11/2020
- Best Practice [RTF] – Last updated 30/11/2020
- Word [doc] – Last updated 30/11/2020
- GP Mental Health Treatment Plan Minimal Requirements [doc] – Last updated 31/07/2018
- GP Heart Health Assessment BP (RTF – Right click, save as)
- GP Heart Health Assessment MD (RTF – Right click, save as)
- Opioid and pain review template [RTF] Best Practice – Last updated 03/09/2020
- Opioid and pain review template [RTF] Medical Director – Last updated 03/09/2020
- Opioid and pain review template [RTF] – Last updated 03/09/2020
How to use the templates
1. Right click on the template link.
2. Select "save link/target as".
3. Open template in your software.
- View opening instructions for Best Practice templates
- View opening instructions for Medical Director templates
- View opening instructions for ZedMed templates
- View opening instructions for Genie templates
- Contact your Practice Support Officer if you require additional support.
Smart Referrals is a digital referrals capability enabling faster, streamlined management of referrals to and within Queensland public hospitals. Visit the Smart Referrals overview page for further details.